Healthcare Provider Details

I. General information

NPI: 1477147726
Provider Name (Legal Business Name): MEGAN DEWITT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2021
Last Update Date: 07/05/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 PRITT LN
BEVERLY WV
26253-4704
US

IV. Provider business mailing address

132 PRITT LN
BEVERLY WV
26253-4704
US

V. Phone/Fax

Practice location:
  • Phone: 681-298-1400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: