Provider Demographics
NPI:1790472280
Name:MOULTON, MEAGAN (PA)
Entity type:Individual
Prefix:
First Name:MEAGAN
Middle Name:
Last Name:MOULTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2555 S DOWNING ST FL 1
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-5856
Mailing Address - Country:US
Mailing Address - Phone:303-316-6677
Mailing Address - Fax:303-316-5004
Practice Address - Street 1:2555 S DOWNING ST FL 1
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5856
Practice Address - Country:US
Practice Address - Phone:303-316-6677
Practice Address - Fax:303-316-5004
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.9368363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant