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General NPI Number Information
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NPI Number | 1922669191
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Entity Type | Individual
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Provider Name | MEAGAN REDOUTEY PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/27/2019
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 619 E MASON ST STE 4P57
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City | SPRINGFIELD
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State | IL
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Zip | 62701-1034
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Country | US
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Telephone | 217-788-0706
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Fax | 217-525-2535
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Provider Business Mailing Address
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Address Line | 619 E MASON ST STE 4P57
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City | SPRINGFIELD
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State | IL
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Zip | 62701-1034
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Country | US
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Telephone | 217-788-0706
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Fax | 217-525-2535
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50.006026RX
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085.008365
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License Number State | IL
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