Healthcare Provider Details

I. General information

NPI: 1053978007
Provider Name (Legal Business Name): MEGAN RADCLIFF FNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2019
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1512 36TH ST
PARKERSBURG WV
26104-1942
US

IV. Provider business mailing address

1512 36TH ST
PARKERSBURG WV
26104-1942
US

V. Phone/Fax

Practice location:
  • Phone: 304-944-9346
  • Fax: 304-944-3054
Mailing address:
  • Phone: 304-944-9346
  • Fax: 304-944-3054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number103131
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2022140757
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: