Provider Demographics
NPI:1164291423
Name:REYES, MEGAN (CPNP-AC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:REYES
Suffix:
Gender:F
Credentials:CPNP-AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9330 FESTIVAL WAY
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-3289
Mailing Address - Country:US
Mailing Address - Phone:505-331-9645
Mailing Address - Fax:
Practice Address - Street 1:9330 FESTIVAL WAY
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-3289
Practice Address - Country:US
Practice Address - Phone:505-331-9645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-28
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC-APN.0101512-C-NP363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care