Healthcare Provider Details

I. General information

NPI: 1528577343
Provider Name (Legal Business Name): MEGAN RENEE WORTH PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN RENEE FARRELL

II. Dates (important events)

Enumeration Date: 09/25/2017
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 S HALCYON RD STE 105
ARROYO GRANDE CA
93420-3839
US

IV. Provider business mailing address

1941 JOHNSON AVE STE 101
SAN LUIS OBISPO CA
93401-4154
US

V. Phone/Fax

Practice location:
  • Phone: 805-782-8844
  • Fax: 805-782-8859
Mailing address:
  • Phone: 805-782-8844
  • Fax: 805-782-8859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number59581
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA-1526
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: