Provider Demographics
NPI:1285288977
Name:WARDEN, MEGAN JAY (FNP-C)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:JAY
Last Name:WARDEN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 ROSEMONT DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80911-1665
Mailing Address - Country:US
Mailing Address - Phone:937-689-4288
Mailing Address - Fax:
Practice Address - Street 1:1120 MINNEQUA AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-3734
Practice Address - Country:US
Practice Address - Phone:719-281-3285
Practice Address - Fax:719-284-4630
Is Sole Proprietor?:No
Enumeration Date:2019-07-31
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0994850-NP363LF0000X, 363LP2300X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care