Healthcare Provider Details

I. General information

NPI: 1508287467
Provider Name (Legal Business Name): MEGAN JOELLE LARSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2013
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3066 E MERIDIAN PARK LOOP
WASILLA AK
99654-7254
US

IV. Provider business mailing address

3331 E MERIDIAN PARK LOOP
WASILLA AK
99654-7294
US

V. Phone/Fax

Practice location:
  • Phone: 907-357-9590
  • Fax: 907-357-9593
Mailing address:
  • Phone: 907-864-4625
  • Fax: 907-313-1540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3824
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2306
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: