Provider Demographics
NPI:1861010506
Name:AVERY, MEGAN NICOLLE (PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:NICOLLE
Last Name:AVERY
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8800 US HIGHWAY 380 STE 600
Mailing Address - Street 2:
Mailing Address - City:CROSSROADS
Mailing Address - State:TX
Mailing Address - Zip Code:76227-2516
Mailing Address - Country:US
Mailing Address - Phone:940-365-5711
Mailing Address - Fax:
Practice Address - Street 1:8800 US HIGHWAY 380 STE 600
Practice Address - Street 2:
Practice Address - City:CROSSROADS
Practice Address - State:TX
Practice Address - Zip Code:76227-2516
Practice Address - Country:US
Practice Address - Phone:940-365-5711
Practice Address - Fax:940-365-5722
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1002643363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health