Healthcare Provider Details

I. General information

NPI: 1154771699
Provider Name (Legal Business Name): MEGAN R. RALSTON M.S., FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 N MAIN ST
LAPEL IN
46051-9671
US

IV. Provider business mailing address

6626 E 75TH ST STE 500
INDIANAPOLIS IN
46250-2890
US

V. Phone/Fax

Practice location:
  • Phone: 765-298-4480
  • Fax: 765-534-3022
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71006432A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: