Provider Demographics
NPI:1790072114
Name:MARTIN, MEGAN R (NP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:R
Last Name:MARTIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:R
Other - Last Name:HOVERMALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2800 E DESERT INN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-3609
Mailing Address - Country:US
Mailing Address - Phone:702-731-1616
Mailing Address - Fax:702-734-4900
Practice Address - Street 1:2800 E DESERT INN RD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-3609
Practice Address - Country:US
Practice Address - Phone:702-731-1616
Practice Address - Fax:702-734-4900
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28176882A163W00000X
NVAPRN002621163WM0705X, 363LA2200X
IN71003807A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201042250Medicaid
IN000000740488OtherANTHEM PROVIDER NUMBER
NV1790072114Medicaid
NV1790072114Medicaid
INP01202290Medicare PIN
IN000000740488OtherANTHEM PROVIDER NUMBER
IN201042250Medicaid