Provider Demographics
NPI:1699118786
Name:RICHARDSON, MEGAN (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11717 OLD NATIONAL PIKE
Mailing Address - Street 2:SUITE #8
Mailing Address - City:NEW MARKET
Mailing Address - State:MD
Mailing Address - Zip Code:21774-6154
Mailing Address - Country:US
Mailing Address - Phone:301-882-7489
Mailing Address - Fax:301-882-7520
Practice Address - Street 1:11717 OLD NATIONAL PIKE
Practice Address - Street 2:SUITE #8
Practice Address - City:NEW MARKET
Practice Address - State:MD
Practice Address - Zip Code:21774-6154
Practice Address - Country:US
Practice Address - Phone:301-882-7489
Practice Address - Fax:301-882-7520
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC001133363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily