Provider Demographics
NPI:1699336321
Name:OLIVER, MEGAN BAILEY (PA-C)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:BAILEY
Last Name:OLIVER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:BAILEY
Other - Last Name:FRAUENDORFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5825 CALLAGHAN RD STE 203
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-1107
Mailing Address - Country:US
Mailing Address - Phone:210-341-9614
Mailing Address - Fax:
Practice Address - Street 1:2829 BABCOCK RD STE 117
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-6009
Practice Address - Country:US
Practice Address - Phone:210-341-9614
Practice Address - Fax:210-340-5924
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPENDING363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant