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1093119661 NPI number — MEGAN M CUNNINGHAM PA-C

NPI Number: 1093119661
Health Care Provider/Practitioner: MEGAN M CUNNINGHAM PA-C

Information about “1093119661” NPI (MEGAN M CUNNINGHAM PA-C) exists in 1093119661 in HTML format HTML  |  1093119661 in plain Text format TXT  |  1093119661 in PDF (Portable Document Format) PDF  |  1093119661 in an XML format XML  formats.

NPI Number : 1093119661 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1093119661",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CUNNINGHAM",
    "FirstName": "MEGAN",
    "MiddleName": "M",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MCNALLY",
    "OtherFirstName": "MEGAN",
    "OtherMiddleName": "M",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "PA-C",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "6823 ISAACS ORCHARD RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SPRINGDALE",
    "MailingAddressStateName": "AR",
    "MailingAddressPostalCode": "72762-6096",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "479-750-2080",
    "MailingAddressFaxNumber": "479-750-2082",
    "FirstLinePracticeLocationAddress": "8600 N STATE ROUTE 91",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PEORIA",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "61615-9541",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "309-683-5050",
    "PracticeLocationAddressFaxNumber": "309-683-5335",
    "EnumerationDate": "10/10/2014",
    "LastUpdateDate": "08/10/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363A00000X",
        "TaxonomyName": "Physician Assistant",
        "LicenseNumber": "085-005302",
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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