Provider Demographics
NPI:1871089524
Name:KILLIAN, MEGAN MARIE (MEGAN)
Entity type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:MARIE
Last Name:KILLIAN
Suffix:
Gender:F
Credentials:MEGAN
Other - Prefix:MISS
Other - First Name:MEGAN
Other - Middle Name:MARIE
Other - Last Name:ESTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:417 CISCO ST APT A
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-1101
Mailing Address - Country:US
Mailing Address - Phone:760-977-9498
Mailing Address - Fax:
Practice Address - Street 1:1400 N NORMA ST STE 133
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555
Practice Address - Country:US
Practice Address - Phone:760-499-7406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2018-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic