Provider Demographics
NPI:1730500265
Name:ROUCHKA, MEGHAN L (PA-C)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:L
Last Name:ROUCHKA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:L
Other - Last Name:FRALEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:901 E 104TH ST
Mailing Address - Street 2:MAILSTOP 400S
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131
Mailing Address - Country:US
Mailing Address - Phone:913-491-9100
Mailing Address - Fax:
Practice Address - Street 1:5844 NW BARRY RD STE 270
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64154-1466
Practice Address - Country:US
Practice Address - Phone:913-491-9100
Practice Address - Fax:913-491-9135
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-31
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013045538363A00000X
KS1501669363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant