Healthcare Provider Details

I. General information

NPI: 1619377553
Provider Name (Legal Business Name): MEGAN EADES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN KEESEE

II. Dates (important events)

Enumeration Date: 08/28/2014
Last Update Date: 09/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 ATHERHOLT RD
LYNCHBURG VA
24501-2148
US

IV. Provider business mailing address

34346 STAGECOACH RD
GLADE SPRING VA
24340-5164
US

V. Phone/Fax

Practice location:
  • Phone: 434-200-5252
  • Fax:
Mailing address:
  • Phone: 276-608-4634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024171746
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20146
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: