Healthcare Provider Details

I. General information

NPI: 1265229447
Provider Name (Legal Business Name): MEAGHAN DAWN TATE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEAGHAN D GLENN

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 E MAIN ST
BECKLEY WV
25801-4706
US

IV. Provider business mailing address

114 E MAIN ST
BECKLEY WV
25801-4706
US

V. Phone/Fax

Practice location:
  • Phone: 681-238-5238
  • Fax: 681-238-5237
Mailing address:
  • Phone: 681-238-5238
  • Fax: 681-238-5238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: