Provider Demographics
NPI:1285288274
Name:JOHNSON, MEGAN CECILE
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:CECILE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7924 NE 53RD ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64119-4149
Mailing Address - Country:US
Mailing Address - Phone:816-438-1479
Mailing Address - Fax:
Practice Address - Street 1:7924 NE 53RD ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64119-4149
Practice Address - Country:US
Practice Address - Phone:816-438-1479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-28
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS80050363LW0102X
MO2003010322363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMHA422658283459OtherPRIVATE INSURANCE