Provider Demographics
NPI:1720698640
Name:ROSA, MEGAN ELAINE (PA-C)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ELAINE
Last Name:ROSA
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:PO BOX 5291
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79704-5291
Mailing Address - Country:US
Mailing Address - Phone:432-221-4243
Mailing Address - Fax:432-221-5981
Practice Address - Street 1:2706 W CUTHBERT AVE STE C
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-3887
Practice Address - Country:US
Practice Address - Phone:432-687-0311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA15179363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty