Healthcare Provider Details

I. General information

NPI: 1619335122
Provider Name (Legal Business Name): MEGHAN JOHNSON DAULTON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2016
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 PINECROFT DR SUITE 250
SHENANDOAH TX
77380-3279
US

IV. Provider business mailing address

9200 PINECROFT DR SUITE 250
SHENANDOAH TX
77380-3279
US

V. Phone/Fax

Practice location:
  • Phone: 281-419-8400
  • Fax: 281-292-1972
Mailing address:
  • Phone: 281-419-8400
  • Fax: 281-292-1972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP130146
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: