Healthcare Provider Details

I. General information

NPI: 1740961762
Provider Name (Legal Business Name): MEGAN ASHLEY WILSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 CLUB LN STE 1
CONWAY AR
72034-3681
US

IV. Provider business mailing address

PO BOX 9662
CONWAY AR
72033-9662
US

V. Phone/Fax

Practice location:
  • Phone: 501-329-1510
  • Fax: 501-329-5697
Mailing address:
  • Phone: 501-852-1363
  • Fax: 501-852-1364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-1338
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: