Healthcare Provider Details

I. General information

NPI: 1811490519
Provider Name (Legal Business Name): MEGAN KATHRYN MCCONNELL NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2018
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8244 E US HIGHWAY 36 STE 1310
AVON IN
46123-9627
US

IV. Provider business mailing address

306 HEMLOCK CT
BROWNSBURG IN
46112-8072
US

V. Phone/Fax

Practice location:
  • Phone: 317-838-9355
  • Fax: 317-718-2955
Mailing address:
  • Phone: 765-409-3755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number28169473A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71008223A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: