=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396633186
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEGAN CHERIE MCBRIDE PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2025
-----------------------------------------------------
Last Update Date | 08/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3400 N DYSART RD STE G127
-----------------------------------------------------
City | AVONDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85392-1011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-322-0323
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 749 W ARAPAHO DR
-----------------------------------------------------
City | WANSHIP
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84017-6806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-669-2626
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------