Provider Demographics
NPI:1124535380
Name:GREGORY, MEAGAN ELIZABETH (FNP-C)
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:ELIZABETH
Last Name:GREGORY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:589 CANVAS DR
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-6144
Mailing Address - Country:US
Mailing Address - Phone:704-516-8895
Mailing Address - Fax:
Practice Address - Street 1:6840 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-7133
Practice Address - Country:US
Practice Address - Phone:919-781-8604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5010148363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily