Individual
MEGAN RENEE MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
100 MEDICAL DR, LAKE JACKSON, TX 77566-5674
(979) 297-4411
(214) 712-2487
Mailing address
1717 MAIN ST, SUITE 5200, DALLAS, TX 75201-4612
(214) 712-2067
(214) 712-2487
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
648846
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8Y1761
BCBSTX
—
Enumeration date
01/08/2007
Last updated
01/27/2008
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