Healthcare Provider Details

I. General information

NPI: 1023809464
Provider Name (Legal Business Name): MEGAN PAXSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 ILLIANA DR
TILTON IL
61832-4260
US

IV. Provider business mailing address

721 E COURT ST
PARIS IL
61944-2460
US

V. Phone/Fax

Practice location:
  • Phone: 217-655-4362
  • Fax: 217-463-1593
Mailing address:
  • Phone: 217-465-4141
  • Fax: 217-465-5615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209032959
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: