Provider Demographics
NPI:1710725155
Name:FLOCKER, MEGAN LEE
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:LEE
Last Name:FLOCKER
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 1:816 CHERYL ANN CT
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41183-9529
Mailing Address - Country:US
Mailing Address - Phone:606-694-4444
Mailing Address - Fax:
Practice Address - Street 1:816 CHERYL ANN CT
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:KY
Practice Address - Zip Code:41183-9529
Practice Address - Country:US
Practice Address - Phone:606-694-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1172293390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program