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General NPI Number Information
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NPI Number | 1669619201
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Entity Type | Individual
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Provider Name | MEGAN KRISTINE RUNKEL LMP
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Gender | Female
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Dates
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Enumeration Date | 01/20/2009
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Last Update Date | 01/16/2020
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Provider Practice Location Address
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Address Line | 125 JEFF DAVIS AVE
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City | LONG BEACH
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State | MS
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Zip | 39560-6134
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Country | US
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Telephone | 228-313-9208
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Fax | 228-868-4991
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Provider Business Mailing Address
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Address Line | 125 JEFF DAVIS AVE
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City | LONG BEACH
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State | MS
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Zip | 39560-6134
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Country | US
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Telephone | 228-313-9208
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Fax | 228-868-4991
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 2645
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MA 60018937
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License Number State | WA
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