Healthcare Provider Details

I. General information

NPI: 1710346762
Provider Name (Legal Business Name): MEGAN CARLSON D. O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2016
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1532 W 32ND ST STE 401
JOPLIN MO
64804-1646
US

IV. Provider business mailing address

PO BOX 3810
JOPLIN MO
64803-3810
US

V. Phone/Fax

Practice location:
  • Phone: 417-347-7009
  • Fax: 417-347-3288
Mailing address:
  • Phone: 417-347-7009
  • Fax: 417-347-3288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2020021397
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: