Provider Demographics
NPI:1932517315
Name:MCKERNAN, MEAGAN LOUISE
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:LOUISE
Last Name:MCKERNAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S WHITTIER ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-1045
Mailing Address - Country:US
Mailing Address - Phone:316-444-0140
Mailing Address - Fax:316-689-3541
Practice Address - Street 1:111 S WHITTIER ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-1045
Practice Address - Country:US
Practice Address - Phone:316-444-0104
Practice Address - Fax:316-689-3541
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-29
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2594106H00000X
KS2644106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist