Provider Demographics
NPI:1023392032
Name:BYSTRZYCKI, MEAGAN ANN (PA)
Entity type:Individual
Prefix:
First Name:MEAGAN
Middle Name:ANN
Last Name:BYSTRZYCKI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3149 FREEDOM DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-3869
Practice Address - Country:US
Practice Address - Phone:980-302-9405
Practice Address - Fax:980-302-9406
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-03140363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1023392032Medicaid
SC2208PAMedicaid
NC1023392032Medicaid
NCNC3077CMedicare PIN