Provider Demographics
NPI:1770051666
Name:SANTIAGO, MEGAN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:COWLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:9301 N CENTRAL EXPY STE 340
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-0804
Mailing Address - Country:US
Mailing Address - Phone:142-446-2828
Mailing Address - Fax:
Practice Address - Street 1:9301 N CENTRAL EXPY STE 340
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-0804
Practice Address - Country:US
Practice Address - Phone:214-446-2828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-08
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2018-051363A00000X
TXPA-14721363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant