Healthcare Provider Details

I. General information

NPI: 1790472280
Provider Name (Legal Business Name): MEAGAN MOULTON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2023
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 S DOWNING ST FL 1
DENVER CO
80210-5856
US

IV. Provider business mailing address

2555 S DOWNING ST FL 1
DENVER CO
80210-5856
US

V. Phone/Fax

Practice location:
  • Phone: 303-316-6677
  • Fax: 303-316-5004
Mailing address:
  • Phone: 303-316-6677
  • Fax: 303-316-5004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.9368
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: