Provider Demographics
NPI:1003433590
Name:RADFORD, MEAGAN NICHOLE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:NICHOLE
Last Name:RADFORD
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18877 JEB STUART HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:VA
Mailing Address - Zip Code:24171-5223
Mailing Address - Country:US
Mailing Address - Phone:276-694-4466
Mailing Address - Fax:276-694-2909
Practice Address - Street 1:18877 JEB STUART HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:VA
Practice Address - Zip Code:24171-5223
Practice Address - Country:US
Practice Address - Phone:276-340-9507
Practice Address - Fax:276-694-2909
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024179482363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner