Provider Demographics
NPI:1285306332
Name:MORIARTY, MEGAN CLAUDINE (PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:CLAUDINE
Last Name:MORIARTY
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 SHENANDOAH CT
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-4043
Mailing Address - Country:US
Mailing Address - Phone:765-421-4632
Mailing Address - Fax:
Practice Address - Street 1:1904 SHENANDOAH CT
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4043
Practice Address - Country:US
Practice Address - Phone:765-421-4632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-28
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28175923A163W00000X
IN71012790A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse