Provider Demographics
NPI:1659076859
Name:HOLLEMAN, MEGAN THACKABERRY (PA-C)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:THACKABERRY
Last Name:HOLLEMAN
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:JOAN
Other - Last Name:THACKABERRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:6240 S MAIN ST STE 280
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-5378
Mailing Address - Country:US
Mailing Address - Phone:571-420-2630
Mailing Address - Fax:
Practice Address - Street 1:6240 S MAIN ST STE 280
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-5378
Practice Address - Country:US
Practice Address - Phone:720-274-5715
Practice Address - Fax:720-274-5719
Is Sole Proprietor?:No
Enumeration Date:2023-04-05
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0007870207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology