Provider Demographics
NPI:1992285902
Name:SLACK, MEGAN SIERRA (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:SIERRA
Last Name:SLACK
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6007 U.S. RT. 60. SUITE 130
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504
Mailing Address - Country:US
Mailing Address - Phone:304-733-3333
Mailing Address - Fax:304-733-3666
Practice Address - Street 1:6007 U.S. RT. 60. SUITE 130
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504
Practice Address - Country:US
Practice Address - Phone:304-733-3333
Practice Address - Fax:304-733-3666
Is Sole Proprietor?:No
Enumeration Date:2018-08-19
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV86057363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily