Provider Demographics
NPI:1174248512
Name:VESSELL, MEGAN
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:VESSELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43079 W HARBOR LN
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-5277
Mailing Address - Country:US
Mailing Address - Phone:225-636-6691
Mailing Address - Fax:
Practice Address - Street 1:43079 W HARBOR LN
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-5277
Practice Address - Country:US
Practice Address - Phone:225-636-6691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company