MEDICARE: MRS. MEGAN SANTIAGO PA-C

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	363A00000X	Physician Assistant	PA-14721	TX
2	363A00000X	Physician Assistant	PA-814	AR
3	363A00000X	Physician Assistant	PT2018-051	AR

General Provider Information

NPI Number	:	1770051666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MEGAN SANTIAGO PA-C

Provider Business Mailing Address
First Line	:	1225 BRECKENRIDGE DR STE 110
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-1565
Country	:	US
Telephone Number	:	501-359-6655
Fax Number	:

Provider Business Practice Location Address
First Line	:	1225 BRECKENRIDGE DR STE 110
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-1565
Country	:	US
Telephone Number	:	501-359-6655
Fax Number	:

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

Provider Enumeration Date	:	11/08/2018
Last Update Date	:	12/17/2025

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