Provider Demographics
NPI:1730634510
Name:GRAY, MEAGAN ELIZABETH (FNP-C)
Entity type:Individual
Prefix:
First Name:MEAGAN
Middle Name:ELIZABETH
Last Name:GRAY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MEAGAN
Other - Middle Name:ELIZABETH GRAY
Other - Last Name:KUCHEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:601 CHILDRENS LN
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1971
Mailing Address - Country:US
Mailing Address - Phone:757-668-7000
Mailing Address - Fax:
Practice Address - Street 1:11760 ROCK LANDING DR
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4204
Practice Address - Country:US
Practice Address - Phone:757-668-6300
Practice Address - Fax:757-668-6310
Is Sole Proprietor?:No
Enumeration Date:2016-08-22
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-1044612080P0206X, 363LF0000X
VA0024189156363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology