Healthcare Provider Details

I. General information

NPI: 1992618086
Provider Name (Legal Business Name): MEGAN PARK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

461 21ST AVE S
NASHVILLE TN
37240-1104
US

IV. Provider business mailing address

461 21ST AVE S
NASHVILLE TN
37240-1104
US

V. Phone/Fax

Practice location:
  • Phone: 651-322-4400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN61075466
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: