Provider Demographics
NPI:1023688116
Name:BLACK, MEGAN KATHLEEN (MSN, APRN, AGNP-C)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:KATHLEEN
Last Name:BLACK
Suffix:
Gender:F
Credentials:MSN, APRN, AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3404 WAKE FOREST RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7340
Mailing Address - Country:US
Mailing Address - Phone:919-862-5402
Mailing Address - Fax:
Practice Address - Street 1:3404 WAKE FOREST RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7340
Practice Address - Country:US
Practice Address - Phone:919-862-5402
Practice Address - Fax:919-954-3191
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-30
Last Update Date:2023-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5014633363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health