Provider Demographics
NPI:1922107556
Name:KENNEDY SHEDDEN, MEGAN BLAIR (PAC)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:BLAIR
Last Name:KENNEDY SHEDDEN
Suffix:
Gender:F
Credentials:PAC
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Mailing Address - Street 1:9200 NEW TRAILS DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-5257
Mailing Address - Country:US
Mailing Address - Phone:281-364-9509
Mailing Address - Fax:281-364-0984
Practice Address - Street 1:9200 NEW TRAILS DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-5257
Practice Address - Country:US
Practice Address - Phone:281-364-9509
Practice Address - Fax:281-364-9509
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2011-04-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA03105363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ29109Medicare UPIN