MEDICARE: MRS. MEGAN RENEE CROWE PMHNPBC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	2015023323	MO
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	2022025020	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407588643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MEGAN RENEE CROWE PMHNPBC

Provider Business Mailing Address
First Line	:	106 S FARRAR DR STE 109
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63701-4912
Country	:	US
Telephone Number	:	573-334-7055
Fax Number	:	573-334-7961

Provider Business Practice Location Address
First Line	:	106 S FARRAR DR STE 109
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63701-4912
Country	:	US
Telephone Number	:	573-334-7055
Fax Number	:	573-334-7961

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2022
Last Update Date	:	09/09/2024

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