Provider Demographics
NPI:1982088696
Name:SMITH, MEGHANN (PA-C)
Entity Type:Individual
Prefix:
First Name:MEGHANN
Middle Name:
Last Name:SMITH
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:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-643-7100
Mailing Address - Fax:515-643-7145
Practice Address - Street 1:2605 SW WHITE BIRCH DR
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-7204
Practice Address - Country:US
Practice Address - Phone:515-643-7100
Practice Address - Fax:515-643-7145
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA079068363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant