Provider Demographics
NPI:1770350019
Name:DAVIS, MEGAN (PMHNP)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:MAUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:424 YELLOWSTONE AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-9310
Mailing Address - Country:US
Mailing Address - Phone:307-578-2919
Mailing Address - Fax:
Practice Address - Street 1:424 YELLOWSTONE AVE STE 220
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-9310
Practice Address - Country:US
Practice Address - Phone:307-578-2277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY51129163W00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse