Provider Demographics
NPI:1154771699
Name:RALSTON, MEGAN R (MS, FNP-C)
Entity type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:R
Last Name:RALSTON
Suffix:
Gender:F
Credentials:MS, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST STE 500
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1675 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LAPEL
Practice Address - State:IN
Practice Address - Zip Code:46051-9671
Practice Address - Country:US
Practice Address - Phone:765-298-4480
Practice Address - Fax:765-534-3022
Is Sole Proprietor?:No
Enumeration Date:2016-06-15
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006432A363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
INQ00344299OtherRAILROAD MEDICARE