Provider Demographics
NPI:1144578063
Name:MACKEY, MEGAN JANETTE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:JANETTE
Last Name:MACKEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NCI NOB BLOCH BLDG 82
Mailing Address - Street 2:9030 OLD GEORGETOWN ROAD
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20892-1643
Mailing Address - Country:US
Mailing Address - Phone:301-402-3435
Mailing Address - Fax:
Practice Address - Street 1:NCI NOB BLOCH BLDG 82
Practice Address - Street 2:9030 OLD GEORGETOWN ROAD
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-1643
Practice Address - Country:US
Practice Address - Phone:301-402-3435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR177075363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health