MEDICARE: MEGHAN NASH CANNAVAN P.A.

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	PA030416	DC
2	363A00000X	Physician Assistant	C0003268	MD
3	363A00000X	Physician Assistant	0110002219	VA
4	363A00000X	Physician Assistant	2012001745	MO

General Provider Information

NPI Number	:	1861563926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGHAN NASH CANNAVAN P.A.

Provider Business Mailing Address
First Line	:	5844 NW BARRY RD
Second Line	:	STE 310
City	:	KANSAS CITY
State	:	MO
Zip	:	64154-1421
Country	:	US
Telephone Number	:	816-741-9122
Fax Number	:	816-741-9665

Provider Business Practice Location Address
First Line	:	5844 NW BARRY RD
Second Line	:	STE 310
City	:	KANSAS CITY
State	:	MO
Zip	:	64154-1421
Country	:	US
Telephone Number	:	816-741-9122
Fax Number	:	816-741-9665

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

Provider Enumeration Date	:	11/12/2006
Last Update Date	:	05/13/2015

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