Provider Demographics
NPI:1003596206
Name:DALE, MEGAN MCCOY
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:MCCOY
Last Name:DALE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12902 PLANK RD
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:LA
Mailing Address - Zip Code:70714-4911
Mailing Address - Country:US
Mailing Address - Phone:225-774-0733
Mailing Address - Fax:225-774-7777
Practice Address - Street 1:12902 PLANK RD
Practice Address - Street 2:
Practice Address - City:BAKER
Practice Address - State:LA
Practice Address - Zip Code:70714-4911
Practice Address - Country:US
Practice Address - Phone:225-774-0733
Practice Address - Fax:225-774-7777
Is Sole Proprietor?:No
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA230205363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily