Provider Demographics
NPI:1750758918
Name:ROBERTS, MEGAN ANNE (PA-C)
Entity type:Individual
Prefix:MISS
First Name:MEGAN
Middle Name:ANNE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4611 GUADALUPE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-2928
Mailing Address - Country:US
Mailing Address - Phone:512-476-2830
Mailing Address - Fax:512-476-2832
Practice Address - Street 1:4611 GUADALUPE ST STE 200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-2928
Practice Address - Country:US
Practice Address - Phone:512-476-2830
Practice Address - Fax:512-476-2832
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA10047363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX350003501Medicaid
TX350003502OtherCSHCN
TX350003501Medicaid