Provider Demographics
NPI:1407494883
Name:PANKEY, MEGHAN R (APRN-FNP)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:R
Last Name:PANKEY
Suffix:
Gender:F
Credentials:APRN-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1464 JEFFERSON ST N
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-1380
Mailing Address - Country:US
Mailing Address - Phone:304-645-3220
Mailing Address - Fax:844-479-4545
Practice Address - Street 1:1464 JEFFERSON ST N
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-1380
Practice Address - Country:US
Practice Address - Phone:304-645-3220
Practice Address - Fax:844-479-4545
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-16
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV104229363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV104229OtherWV LICENSE