Provider Demographics
NPI:1154981470
Name:HUBBARD, MEGAN PAIGE (FNP-BC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:PAIGE
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 BEAT LINE HINZE RD
Mailing Address - Street 2:
Mailing Address - City:MC COOL
Mailing Address - State:MS
Mailing Address - Zip Code:39108-9753
Mailing Address - Country:US
Mailing Address - Phone:662-803-7832
Mailing Address - Fax:
Practice Address - Street 1:8613 MS HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:ACKERMAN
Practice Address - State:MS
Practice Address - Zip Code:39735-8917
Practice Address - Country:US
Practice Address - Phone:662-285-9460
Practice Address - Fax:662-285-9324
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902690363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily