Provider Demographics
NPI:1528608908
Name:SUTPHIN, MEGAN PAIGE (PA-C)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:PAIGE
Last Name:SUTPHIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 HEART DR STE A
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2607
Mailing Address - Country:US
Mailing Address - Phone:703-851-8564
Mailing Address - Fax:
Practice Address - Street 1:161 HEART DR STE A
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2607
Practice Address - Country:US
Practice Address - Phone:703-851-8564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-13
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant