Provider Demographics
NPI:1194557330
Name:CARBAUGH, MEGAN KATHLEEN (PA-C)
Entity type:Individual
Prefix:MISS
First Name:MEGAN
Middle Name:KATHLEEN
Last Name:CARBAUGH
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:507 W KENDALL DR
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-1095
Practice Address - Country:US
Practice Address - Phone:630-357-7536
Practice Address - Fax:630-904-0413
Is Sole Proprietor?:No
Enumeration Date:2024-08-16
Last Update Date:2025-01-13
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Provider Licenses
StateLicense IDTaxonomies
IL085.010573363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant