Provider Demographics
NPI:1306686928
Name:BLACKWELL, MEAGAN BRADY (DNP, CPNP-AC)
Entity type:Individual
Prefix:
First Name:MEAGAN
Middle Name:BRADY
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:DNP, CPNP-AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5155 EDENHURST RD
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-1216
Mailing Address - Country:US
Mailing Address - Phone:724-263-0311
Mailing Address - Fax:
Practice Address - Street 1:2101 ADELBERT RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-2624
Practice Address - Country:US
Practice Address - Phone:216-844-1738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.432067163W00000X
OHAPRN.CNP.0035515363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse