Provider Demographics
NPI:1952636516
Name:CARROLL, MEGHAN DANELLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MEGHAN
Middle Name:DANELLE
Last Name:CARROLL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 S 4TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-5071
Mailing Address - Country:US
Mailing Address - Phone:913-680-6200
Mailing Address - Fax:913-680-6348
Practice Address - Street 1:3550 S 4TH ST STE B
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-5071
Practice Address - Country:US
Practice Address - Phone:913-680-6200
Practice Address - Fax:913-680-6348
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06440363A00000X
TXTX TEMPORARY363AM0700X
KS15-02415363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS15-02415OtherSTATE LICENSE