Provider Demographics
NPI:1336806652
Name:COFFEY, MEGHAN MICHELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:MICHELLE
Last Name:COFFEY
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 1:100 KNOTBREAK RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-5414
Mailing Address - Country:US
Mailing Address - Phone:540-205-3351
Mailing Address - Fax:
Practice Address - Street 1:100 KNOTBREAK RD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-5414
Practice Address - Country:US
Practice Address - Phone:540-205-3351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-22
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty