Provider Demographics
NPI:1124460308
Name:MCCREADY, NATALIE JO (PA-C)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:JO
Last Name:MCCREADY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 COLDSTREAM DR
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-5872
Mailing Address - Country:US
Mailing Address - Phone:412-522-4305
Mailing Address - Fax:
Practice Address - Street 1:6040 UNIVERSITY TOWN CENTRE DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-2421
Practice Address - Country:US
Practice Address - Phone:304-293-6307
Practice Address - Fax:304-293-1216
Is Sole Proprietor?:No
Enumeration Date:2013-07-29
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056230363AM0700X
WV01796363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical