Provider Demographics
NPI:1922669191
Name:REDOUTEY, MEAGAN (PA-C)
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:
Last Name:REDOUTEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MEAGAN
Other - Middle Name:
Other - Last Name:BEERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:201 E MADISON ST STE 328
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-5131
Mailing Address - Country:US
Mailing Address - Phone:217-545-8000
Mailing Address - Fax:
Practice Address - Street 1:751 N RUTLEDGE ST STE 3100
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-4968
Practice Address - Country:US
Practice Address - Phone:217-545-6523
Practice Address - Fax:217-545-4410
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.006026RX363A00000X
IL085.008365363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant