Provider Demographics
NPI:1992475792
Name:ACHESON, MEGAN (CHW-C, CPHT)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:ACHESON
Suffix:
Gender:F
Credentials:CHW-C, CPHT
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:CARNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CHW-C, CPHT
Mailing Address - Street 1:1173 E HINES ST
Mailing Address - Street 2:
Mailing Address - City:REPUBLIC
Mailing Address - State:MO
Mailing Address - Zip Code:65738-1277
Mailing Address - Country:US
Mailing Address - Phone:417-735-0055
Mailing Address - Fax:417-732-1529
Practice Address - Street 1:1173 E HINES ST
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:MO
Practice Address - Zip Code:65738-1277
Practice Address - Country:US
Practice Address - Phone:417-735-0055
Practice Address - Fax:417-732-1529
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-14
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
MO2014002767183700000X
MO12454172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No174H00000XOther Service ProvidersHealth Educator
No183700000XPharmacy Service ProvidersPharmacy Technician