Healthcare Provider Details

I. General information

NPI: 1215748124
Provider Name (Legal Business Name): MEGAN MEBRUER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2025
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 US HIGHWAY 61
FESTUS MO
63028-4100
US

IV. Provider business mailing address

3059 BECK ADDITION RD
UNION MO
63084-3829
US

V. Phone/Fax

Practice location:
  • Phone: 636-933-1000
  • Fax:
Mailing address:
  • Phone: 636-388-6611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2025004863
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: