Provider Demographics
NPI:1467173773
Name:HENRY, MEGAN RENEE
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:RENEE
Last Name:HENRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2858 GLEN DALE HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:GLEN DALE
Mailing Address - State:WV
Mailing Address - Zip Code:26038-1170
Mailing Address - Country:US
Mailing Address - Phone:304-312-5128
Mailing Address - Fax:
Practice Address - Street 1:2858 GLEN DALE HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:GLEN DALE
Practice Address - State:WV
Practice Address - Zip Code:26038-1170
Practice Address - Country:US
Practice Address - Phone:304-312-5128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1356607394Medicaid
WV125553494Medicaid
WV1821206228Medicaid