Provider Demographics
NPI:1588331177
Name:KNOBLOCH, MEGAN S (AA)
Entity type:Individual
Prefix:MISS
First Name:MEGAN
Middle Name:S
Last Name:KNOBLOCH
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:A
Other - Last Name:SHEA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AA
Mailing Address - Street 1:PO BOX 840862
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0862
Mailing Address - Country:US
Mailing Address - Phone:303-377-7638
Mailing Address - Fax:303-780-0787
Practice Address - Street 1:8000 E MAPLEWOOD AVE STE 120
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-4766
Practice Address - Country:US
Practice Address - Phone:303-438-3999
Practice Address - Fax:720-439-9500
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMAA2021-001367H00000X
COANT.0000228367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant