Provider Demographics
NPI:1235588542
Name:GORST, MEGAN LEE (NP-C)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:LEE
Last Name:GORST
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14845 MOUNT EDEN RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT EDEN
Mailing Address - State:KY
Mailing Address - Zip Code:40046-7001
Mailing Address - Country:US
Mailing Address - Phone:480-255-9655
Mailing Address - Fax:
Practice Address - Street 1:14845 MOUNT EDEN RD
Practice Address - Street 2:
Practice Address - City:MOUNT EDEN
Practice Address - State:KY
Practice Address - Zip Code:40046-7001
Practice Address - Country:US
Practice Address - Phone:480-255-9655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2025-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3015736363L00000X
AZ225172363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM75206323Medicaid
NM75206323Medicaid