Provider Demographics
NPI:1982141107
Name:TILLMAN, MEGAN W (CRNP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:W
Last Name:TILLMAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:L
Other - Last Name:WEAVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:287 HEALTHWEST DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-2031
Mailing Address - Country:US
Mailing Address - Phone:334-792-9500
Mailing Address - Fax:334-793-4804
Practice Address - Street 1:287 HEALTHWEST DR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-2031
Practice Address - Country:US
Practice Address - Phone:334-792-9500
Practice Address - Fax:334-793-4804
Is Sole Proprietor?:No
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-131459363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily