Provider Demographics
NPI:1811395239
Name:OWEN, MEAGAN (MS, RDN)
Entity Type:Individual
Prefix:MRS
First Name:MEAGAN
Middle Name:
Last Name:OWEN
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:MISS
Other - First Name:MEAGAN
Other - Middle Name:C
Other - Last Name:WALLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:800 OAK ST
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-1199
Mailing Address - Country:US
Mailing Address - Phone:434-315-2860
Mailing Address - Fax:434-315-2865
Practice Address - Street 1:937 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901
Practice Address - Country:US
Practice Address - Phone:434-414-3951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-17
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA86039973133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered