Provider Demographics
NPI:1538945431
Name:WATHEN, MEGAN M (NP)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:M
Last Name:WATHEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:M
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3366
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47732-3366
Mailing Address - Country:US
Mailing Address - Phone:812-867-8991
Mailing Address - Fax:812-867-8995
Practice Address - Street 1:15814 NEELEY ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47725-8420
Practice Address - Country:US
Practice Address - Phone:812-867-8991
Practice Address - Fax:812-867-8995
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71014409A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner