Individual
MRS. MEGGAN MICHELLE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
12855 N 40 DR STE 350, SAINT LOUIS, MO 63141-8669
(314) 567-6071
Mailing address
12855 N 40 DR STE 375, SAINT LOUIS, MO 63141-8657
(314) 567-6071
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085009473
IL
363A00000X
Physician Assistant
Primary
2021041128
MO
363A00000X
Physician Assistant
PA04904
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
113620067
MEDICARE
MO
Enumeration date
07/21/2006
Last updated
02/08/2023
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