Individual
MISS MEGAN AUDRA COURTNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, ATC
Contact information
Practice address
13151 MAGISTERIAL DR STE 200, LOUISVILLE, KY 40223-4103
(502) 587-1236
Mailing address
13151 MAGISTERIAL DR STE 200, LOUISVILLE, KY 40223-4103
(502) 587-1236
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA1655
KY
363AM0700X
Medical Physician Assistant
10001823A
IN
363AM0700X
Medical Physician Assistant
PA1655
KY
363AS0400X
Surgical Physician Assistant
10001823A
IN
363AS0400X
Surgical Physician Assistant
PA1655
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000728596
ANTHEM BC/BS
KY
05
—
300008425
—
IN
05
—
7100193870
—
KY
01
—
P01122799
RR MEDICARE
KY
Enumeration date
05/20/2006
Last updated
07/18/2024
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