Provider Demographics
NPI:1164213740
Name:MILLARD, MEGAN
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:MILLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 E 2ND AVE UNIT 105
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-4250
Mailing Address - Country:US
Mailing Address - Phone:614-284-4440
Mailing Address - Fax:
Practice Address - Street 1:1080 BEECHER XING N
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-4576
Practice Address - Country:US
Practice Address - Phone:855-687-6227
Practice Address - Fax:855-687-6227
Is Sole Proprietor?:No
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.009447RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant