Basic Information
| Provider Information | |||||||||
| NPI: | 1952798779 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JUAREZ | ||||||||
| FirstName: | MEGAN | ||||||||
| MiddleName: | ALYSE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1305 WONDER WORLD DRIVE SUITE 308 | ||||||||
| Address2: | |||||||||
| City: | SAN MARCOS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123536428 | ||||||||
| FaxNumber: | 5127534929 | ||||||||
| Practice Location | |||||||||
| Address1: | 1320 WONDER WORLD DR STE 101 | ||||||||
| Address2: | |||||||||
| City: | SAN MARCOS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786667558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123963911 | ||||||||
| FaxNumber: | 5123530807 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2015 | ||||||||
| LastUpdateDate: | 07/16/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP127917 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.