Healthcare Provider Details

I. General information

NPI: 1306578398
Provider Name (Legal Business Name): MEGAN ABIGAIL CAUDLE-PATTON RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8801 FAST PARK DR STE 213
RALEIGH NC
27617-4853
US

IV. Provider business mailing address

2533 VALLEY HAVEN DR
RALEIGH NC
27603-3303
US

V. Phone/Fax

Practice location:
  • Phone: 919-442-8398
  • Fax:
Mailing address:
  • Phone: 704-437-3267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL006919
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: