Healthcare Provider Details

I. General information

NPI: 1700506631
Provider Name (Legal Business Name): MEGAN SUE MCCORMICK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2022
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 E PARRISH AVE STE 101C
OWENSBORO KY
42303-1450
US

IV. Provider business mailing address

PO BOX 23229
OWENSBORO KY
42304-3229
US

V. Phone/Fax

Practice location:
  • Phone: 270-688-1650
  • Fax:
Mailing address:
  • Phone: 270-688-1330
  • Fax: 270-688-1338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3018244
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: