Healthcare Provider Details

I. General information

NPI: 1770051666
Provider Name (Legal Business Name): MEGAN SANTIAGO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN COWLING PA-C

II. Dates (important events)

Enumeration Date: 11/08/2018
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 BRECKENRIDGE DR STE 110
LITTLE ROCK AR
72205-1565
US

IV. Provider business mailing address

1225 BRECKENRIDGE DR STE 110
LITTLE ROCK AR
72205-1565
US

V. Phone/Fax

Practice location:
  • Phone: 501-359-6655
  • Fax:
Mailing address:
  • Phone: 501-359-6655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-14721
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-814
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPT2018-051
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: