Provider Demographics
NPI:1407683311
Name:MARTIN, MEAGAN (CHW)
Entity type:Individual
Prefix:MRS
First Name:MEAGAN
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2022 AUGUSTA ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75146-1292
Mailing Address - Country:US
Mailing Address - Phone:469-245-9793
Mailing Address - Fax:
Practice Address - Street 1:2022 AUGUSTA ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75146-1292
Practice Address - Country:US
Practice Address - Phone:469-245-9793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13086172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker