Provider Demographics
NPI:1871926766
Name:PATRICK, MEGAN LESLEE (DNP, ARNP)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:LESLEE
Last Name:PATRICK
Suffix:
Gender:F
Credentials:DNP, ARNP
Other - Prefix:DR
Other - First Name:MEGAN
Other - Middle Name:LESLEE
Other - Last Name:MORTENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, ARNP
Mailing Address - Street 1:6950 NE 14TH ST STE 36
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-8903
Mailing Address - Country:US
Mailing Address - Phone:515-295-1515
Mailing Address - Fax:515-295-1511
Practice Address - Street 1:6950 NE 14TH ST STE 36
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-8903
Practice Address - Country:US
Practice Address - Phone:515-295-1515
Practice Address - Fax:515-295-1511
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA123245363LF0000X
WI10108-33363LP0808X
IAG123245363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily