MEDICARE: MEGAN RENEA ACKLEY

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	172A00000X	Driver

General Provider Information

NPI Number	:	1700767431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN RENEA ACKLEY

Provider Business Mailing Address
First Line	:	903 BURT ST
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45505-3218
Country	:	US
Telephone Number	:	937-926-0532
Fax Number	:

Provider Business Practice Location Address
First Line	:	903 BURT ST
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45505-3218
Country	:	US
Telephone Number	:	937-926-0532
Fax Number	:

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

Provider Enumeration Date	:	09/09/2025
Last Update Date	:	09/09/2025

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