Provider Demographics
NPI:1780400853
Name:STEVENS, MEGAN ELISE (NP)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ELISE
Last Name:STEVENS
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:ELISE
Other - Last Name:BOARMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 959354
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-2328
Mailing Address - Country:US
Mailing Address - Phone:314-996-7272
Mailing Address - Fax:314-996-6785
Practice Address - Street 1:3023 N BALLAS RD STE 200D
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2328
Practice Address - Country:US
Practice Address - Phone:314-996-7272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-22
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025000565363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner