Healthcare Provider Details

I. General information

NPI: 1326993528
Provider Name (Legal Business Name): MEGAN JO MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN JO NICODEMUS

II. Dates (important events)

Enumeration Date: 03/03/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 MERCY DR NW
CANTON OH
44708-2614
US

IV. Provider business mailing address

741 E TUSCARAWAS AVE
BARBERTON OH
44203-3719
US

V. Phone/Fax

Practice location:
  • Phone: 330-489-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number0042543
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: