Healthcare Provider Details

I. General information

NPI: 1588358923
Provider Name (Legal Business Name): MEAGAN ELIZABETH COOMER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 N MAIN ST STE 1C
PRESCOTT VALLEY AZ
86314-1215
US

IV. Provider business mailing address

3001 N MAIN ST STE 1C
PRESCOTT VALLEY AZ
86314-1215
US

V. Phone/Fax

Practice location:
  • Phone: 928-458-5470
  • Fax: 928-458-5979
Mailing address:
  • Phone: 928-458-5470
  • Fax: 928-458-5979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number292951
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: