Healthcare Provider Details

I. General information

NPI: 1760114466
Provider Name (Legal Business Name): MEGAN HERRINGTON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2022
Last Update Date: 11/23/2022
Certification Date: 11/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10777 SUNSET OFFICE DR STE 120
SAINT LOUIS MO
63127-1019
US

IV. Provider business mailing address

248 TOWERS CREEK PL
SAINT CHARLES MO
63304-7404
US

V. Phone/Fax

Practice location:
  • Phone: 314-966-0111
  • Fax:
Mailing address:
  • Phone: 636-352-7575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2022040146
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: