Healthcare Provider Details

I. General information

NPI: 1427334069
Provider Name (Legal Business Name): MEGAN T CORBETT NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2011
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6908 MESA RIDGE PKWY
FOUNTAIN CO
80817-1533
US

IV. Provider business mailing address

6388 BUTCH CASSIDY BLVD
COLORADO SPRINGS CO
80923-7443
US

V. Phone/Fax

Practice location:
  • Phone: 719-337-5379
  • Fax:
Mailing address:
  • Phone: 719-619-8496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0997028-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: