Provider Demographics
NPI:1164504890
Name:HARRISON, MEGAN M (APN)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:M
Last Name:HARRISON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:M
Other - Last Name:HOOOKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:PO BOX 405827
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-5827
Mailing Address - Country:US
Mailing Address - Phone:901-227-4068
Mailing Address - Fax:901-227-4051
Practice Address - Street 1:210 HWY 30 W
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:MS
Practice Address - Zip Code:38652-3112
Practice Address - Country:US
Practice Address - Phone:662-539-7014
Practice Address - Fax:662-314-9501
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR863881363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS020700026OtherTAX ID
MS03756231Medicaid
MS020700026OtherTAX ID
MSQ73180Medicare UPIN