Provider Demographics
NPI:1912565474
Name:KOMONDOREAS, MEAGAN (CPNP-AC)
Entity type:Individual
Prefix:
First Name:MEAGAN
Middle Name:
Last Name:KOMONDOREAS
Suffix:
Gender:F
Credentials:CPNP-AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 ROSE ST # MS 475
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-3078
Mailing Address - Country:US
Mailing Address - Phone:859-323-5625
Mailing Address - Fax:859-323-5289
Practice Address - Street 1:740 S LIMESTONE STE 201
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-3079
Practice Address - Country:US
Practice Address - Phone:859-218-2522
Practice Address - Fax:859-323-3918
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139810363LP0200X
KY3016418363LP0222X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics