Healthcare Provider Details

I. General information

NPI: 1801520192
Provider Name (Legal Business Name): MEGAN WYKOFF FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2022
Last Update Date: 07/12/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 AMALIA DR
BUCKHANNON WV
26201-2200
US

IV. Provider business mailing address

1 AMALIA DR
BUCKHANNON WV
26201-2200
US

V. Phone/Fax

Practice location:
  • Phone: 304-473-2000
  • Fax: 304-473-2309
Mailing address:
  • Phone: 304-473-2000
  • Fax: 304-473-2309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number66992
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: