Healthcare Provider Details

I. General information

NPI: 1215758222
Provider Name (Legal Business Name): MEAGHAN KATHLEEN PURDY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2024
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20375 W 151ST ST STE 105
OLATHE KS
66061-5353
US

IV. Provider business mailing address

686 N PECAN ST
GARDNER KS
66030-7886
US

V. Phone/Fax

Practice location:
  • Phone: 913-355-8100
  • Fax:
Mailing address:
  • Phone: 785-383-5647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15-02954
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: