Provider Demographics
NPI:1255063046
Name:LARA, MEGHAN (PA)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:LARA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:RAE
Other - Last Name:LARA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 749
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-1614
Mailing Address - Country:US
Mailing Address - Phone:956-362-6900
Mailing Address - Fax:956-362-6914
Practice Address - Street 1:5505 S EXPRESSWAY 77 STE 200
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-3214
Practice Address - Country:US
Practice Address - Phone:956-362-6900
Practice Address - Fax:956-362-6914
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA18776363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant