Healthcare Provider Details

I. General information

NPI: 1225624034
Provider Name (Legal Business Name): MEGAN PAIGE BOYTEK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN PAIGE PERRY FNP

II. Dates (important events)

Enumeration Date: 12/15/2020
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4825 MACCORKLE AVE SW STE A
CHARLESTON WV
25309-1365
US

IV. Provider business mailing address

4634 MIDWAY RD
YAWKEY WV
25573-9727
US

V. Phone/Fax

Practice location:
  • Phone: 304-400-4700
  • Fax:
Mailing address:
  • Phone: 681-307-0610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number108000
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number108000
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number108000
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: