Healthcare Provider Details

I. General information

NPI: 1992619936
Provider Name (Legal Business Name): MEGAN WITHEM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 MEADOWS RD
TEXARKANA AR
71854-8307
US

IV. Provider business mailing address

409 MEADOWS RD
TEXARKANA AR
71854-8307
US

V. Phone/Fax

Practice location:
  • Phone: 903-490-3558
  • Fax:
Mailing address:
  • Phone: 903-490-3558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT85812
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-319478
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: