Provider Demographics
NPI:1134987423
Name:LAROCHELLE, MEGAN NICOLE (NP)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:NICOLE
Last Name:LAROCHELLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8214 S ASH PL
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74011-7007
Mailing Address - Country:US
Mailing Address - Phone:918-527-8893
Mailing Address - Fax:
Practice Address - Street 1:129 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HULBERT
Practice Address - State:OK
Practice Address - Zip Code:74441-8901
Practice Address - Country:US
Practice Address - Phone:918-772-3390
Practice Address - Fax:918-772-2244
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK215353363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily