Provider Demographics
NPI:1972052777
Name:HENDERSON, MEAGAN LAVIN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MEAGAN
Middle Name:LAVIN
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:MEAGAN
Other - Middle Name:LAVIN
Other - Last Name:FLODEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:126 6TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:RONAN
Mailing Address - State:MT
Mailing Address - Zip Code:59864-2600
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:126 6TH AVE SW
Practice Address - Street 2:
Practice Address - City:RONAN
Practice Address - State:MT
Practice Address - Zip Code:59864-2600
Practice Address - Country:US
Practice Address - Phone:406-676-3600
Practice Address - Fax:406-676-3738
Is Sole Proprietor?:No
Enumeration Date:2016-09-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-PAC-LIC-51495363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant