Healthcare Provider Details

I. General information

NPI: 1144766080
Provider Name (Legal Business Name): MEGAN LITTLE ND, NBC-HWC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2017
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date: 06/02/2021
Reactivation Date: 09/02/2021

III. Provider practice location address

12817 CRYSTAL AVE
GRANDVIEW MO
64030
US

IV. Provider business mailing address

12817 CRYSTAL AVE
GRANDVIEW MO
64030-2053
US

V. Phone/Fax

Practice location:
  • Phone: 503-724-1408
  • Fax:
Mailing address:
  • Phone: 503-724-1408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA-3155725
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number4045
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: