Provider Demographics
NPI:1255715348
Name:CUPAN, MEAGAN (APRN)
Entity type:Individual
Prefix:
First Name:MEAGAN
Middle Name:
Last Name:CUPAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MEAGAN
Other - Middle Name:
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:2400 STATE FARM RD
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:AR
Mailing Address - Zip Code:72168-9503
Mailing Address - Country:US
Mailing Address - Phone:501-842-2519
Mailing Address - Fax:
Practice Address - Street 1:8901 CARTI WAY
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6523
Practice Address - Country:US
Practice Address - Phone:501-906-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-17
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004462363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily