Provider Demographics
NPI:1871744417
Name:BAIRD, MEGAN NICHOLE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:NICHOLE
Last Name:BAIRD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:NICHOLE
Other - Last Name:DORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1650 COCHRANE CIR BUILDING 7500
Mailing Address - Street 2:
Mailing Address - City:FORT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913
Mailing Address - Country:US
Mailing Address - Phone:719-524-4166
Mailing Address - Fax:719-524-4183
Practice Address - Street 1:1650 COCHRANE CIR.
Practice Address - Street 2:BUILDING 7500
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913
Practice Address - Country:US
Practice Address - Phone:719-524-4166
Practice Address - Fax:719-524-4183
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-04531363A00000X, 363AS0400X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCE881AMedicare UPIN