Healthcare Provider Details

I. General information

NPI: 1124460308
Provider Name (Legal Business Name): NATALIE JO MCCREADY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2013
Last Update Date: 09/14/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6040 UNIVERSITY TOWN CENTRE DR
MORGANTOWN WV
26501-2421
US

IV. Provider business mailing address

1012 COLDSTREAM DR
CANONSBURG PA
15317-5872
US

V. Phone/Fax

Practice location:
  • Phone: 304-293-6307
  • Fax: 304-293-1216
Mailing address:
  • Phone: 412-522-4305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number01796
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA056230
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: