Provider Demographics
NPI:1285155028
Name:FERNANDEZ, MEGAN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 CROSS LANES DR
Mailing Address - Street 2:
Mailing Address - City:CROSS LANES
Mailing Address - State:WV
Mailing Address - Zip Code:25313-1315
Mailing Address - Country:US
Mailing Address - Phone:304-776-9872
Mailing Address - Fax:
Practice Address - Street 1:924 CROSS LANES DR
Practice Address - Street 2:
Practice Address - City:CROSS LANES
Practice Address - State:WV
Practice Address - Zip Code:25313-1315
Practice Address - Country:US
Practice Address - Phone:304-776-9872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-02
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV80999363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily