Healthcare Provider Details

I. General information

NPI: 1235588542
Provider Name (Legal Business Name): MEGAN LEE GORST NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14845 MOUNT EDEN RD
MOUNT EDEN KY
40046-7001
US

IV. Provider business mailing address

14845 MOUNT EDEN RD
MOUNT EDEN KY
40046-7001
US

V. Phone/Fax

Practice location:
  • Phone: 480-255-9655
  • Fax: 480-530-9477
Mailing address:
  • Phone: 480-255-9655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3015736
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number225172
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number225172
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: