Healthcare Provider Details

I. General information

NPI: 1639967599
Provider Name (Legal Business Name): MEGAN SUZANNE CHAMPION
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2025
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2755 HERNDON AVE
CLOVIS CA
93611-6800
US

IV. Provider business mailing address

2037 W BULLARD AVE APT 333
FRESNO CA
93711-1233
US

V. Phone/Fax

Practice location:
  • Phone: 559-299-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA66715
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: