Provider Demographics
NPI:1942231873
Name:MEGA, CAROLYN BLANCHE (FNP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:BLANCHE
Last Name:MEGA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 864
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:SC
Mailing Address - Zip Code:29627-0864
Mailing Address - Country:US
Mailing Address - Phone:864-940-9701
Mailing Address - Fax:864-338-8760
Practice Address - Street 1:113 WILDWOOD DR
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:SC
Practice Address - Zip Code:29627-9687
Practice Address - Country:US
Practice Address - Phone:864-940-9701
Practice Address - Fax:864-338-8760
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCR00047949363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0133Medicaid
SC7117Medicare PIN