Provider Demographics
NPI:1891368254
Name:CHRISTY, MEGAN SUE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:SUE
Last Name:CHRISTY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:SUE
Other - Last Name:WARNCKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4221 MALSBARY RD
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-5526
Mailing Address - Country:US
Mailing Address - Phone:513-241-1811
Mailing Address - Fax:
Practice Address - Street 1:4221 MALSBARY RD
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-5526
Practice Address - Country:US
Practice Address - Phone:513-241-1811
Practice Address - Fax:513-241-2112
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.007051RX363A00000X
OH50.0070512084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry