Healthcare Provider Details

I. General information

NPI: 1528325560
Provider Name (Legal Business Name): MEGAN NICOLE MAYER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2012
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 NE SAINT LUKES BLVD STE 200
LEES SUMMIT MO
64086
US

IV. Provider business mailing address

901 E 104TH ST MAILSTOP 400S
KANSAS CITY MO
64131-1716
US

V. Phone/Fax

Practice location:
  • Phone: 816-246-4302
  • Fax: 816-246-9493
Mailing address:
  • Phone: 816-502-8782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2018009357
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number2018009357
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: