Provider Demographics
NPI:1790116028
Name:TOLAR, MEGAN BOYKIN (AGACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:BOYKIN
Last Name:TOLAR
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:MISS
Other - First Name:MEGAN
Other - Middle Name:NICOLE
Other - Last Name:BOYKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6069
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29171-6069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:222 E MEDICAL LN STE 100&200
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4847
Practice Address - Country:US
Practice Address - Phone:803-935-8410
Practice Address - Fax:803-936-7816
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-12
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20297363L00000X
TN18158363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP4232Medicaid
SCSC96545736Medicare PIN