Provider Demographics
NPI:1184815003
Name:SHEPHERD, MEAGAN WATTS (MD)
Entity type:Individual
Prefix:
First Name:MEAGAN
Middle Name:WATTS
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6007 US ROUTE 60 E STE 130
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-1046
Mailing Address - Country:US
Mailing Address - Phone:304-733-3333
Mailing Address - Fax:
Practice Address - Street 1:6007 US ROUTE 60 E STE 130
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-1046
Practice Address - Country:US
Practice Address - Phone:304-733-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2025-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV25408207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1007102Medicaid