Healthcare Provider Details

I. General information

NPI: 1295641512
Provider Name (Legal Business Name): MEAGAN BRANNON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 BRIDGEVILLE RD
GERMANTOWN KY
41044-9091
US

IV. Provider business mailing address

523 BRIDGEVILLE RD
GERMANTOWN KY
41044-9091
US

V. Phone/Fax

Practice location:
  • Phone: 606-336-2159
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number306851
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: