Provider Demographics
NPI:1215987110
Name:BOOKHOUT, MEGAN JILL (PA)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:JILL
Last Name:BOOKHOUT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:MEGAN
Other - Middle Name:JILL
Other - Last Name:MUNDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2121 E HARMONY RD STE 330
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-3403
Mailing Address - Country:US
Mailing Address - Phone:702-215-8789
Mailing Address - Fax:970-221-3564
Practice Address - Street 1:2211 LOMAS BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2745
Practice Address - Country:US
Practice Address - Phone:505-272-3120
Practice Address - Fax:505-272-8060
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2013-0023363A00000X
COPA.0007045363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant