Healthcare Provider Details

I. General information

NPI: 1134403884
Provider Name (Legal Business Name): MEGAN RENEE MERRIGAN PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2011
Last Update Date: 01/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 GENE GEORGE BLVD
SPRINGDALE AR
72762-0845
US

IV. Provider business mailing address

1 MERCY WAY
BELLA VISTA AR
72714-3000
US

V. Phone/Fax

Practice location:
  • Phone: 479-725-6880
  • Fax: 479-725-6882
Mailing address:
  • Phone: 479-802-5555
  • Fax: 479-876-2829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberA003612
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: