Healthcare Provider Details

I. General information

NPI: 1639508526
Provider Name (Legal Business Name): MEAGAN KATHERINE BLADES PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. MEAGAN KATHERINE GREENE

II. Dates (important events)

Enumeration Date: 11/01/2013
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 N 9TH AVE
PENSACOLA FL
32504-8721
US

IV. Provider business mailing address

1601 CUMMINS DR STE D
MODESTO CA
95358-6411
US

V. Phone/Fax

Practice location:
  • Phone: 850-416-6119
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number51239
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9122233
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: