Provider Demographics
NPI:1619589108
Name:KING, MEGAN (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:CORTEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13937 STAGECOACH RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262-3841
Mailing Address - Country:US
Mailing Address - Phone:817-908-3750
Mailing Address - Fax:
Practice Address - Street 1:9734 N BEACH ST STE 100
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-6185
Practice Address - Country:US
Practice Address - Phone:817-379-9937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1009461363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily