Provider Demographics
NPI:1013794338
Name:MCKAY, MEAGAN SHAMOUN (FNP-C, BSN, RN)
Entity type:Individual
Prefix:MRS
First Name:MEAGAN
Middle Name:SHAMOUN
Last Name:MCKAY
Suffix:
Gender:F
Credentials:FNP-C, BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:784 HENRIETTA ST
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-1967
Mailing Address - Country:US
Mailing Address - Phone:248-497-0964
Mailing Address - Fax:
Practice Address - Street 1:6889 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1658
Practice Address - Country:US
Practice Address - Phone:248-666-5200
Practice Address - Fax:248-666-5069
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704337332207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty