Healthcare Provider Details

I. General information

NPI: 1366748162
Provider Name (Legal Business Name): MEGAN LEIGH GLEASON HUTCHCRAFT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEGAN LEIGH GLEASON MD

II. Dates (important events)

Enumeration Date: 01/27/2011
Last Update Date: 08/31/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 WHITNEY HENDRICKSON BLDG 800 ROSE STREET
LEXINGTON KY
40536-1267
US

IV. Provider business mailing address

508 LINDEN DR
SAINT JOSEPH IL
61873-9433
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-3975
  • Fax: 859-323-1602
Mailing address:
  • Phone: 630-674-1546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number53835
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: