Provider Demographics
NPI:1659196855
Name:MOORE, MEAGAN LACEY (RN)
Entity type:Individual
Prefix:
First Name:MEAGAN
Middle Name:LACEY
Last Name:MOORE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2804 HAYES AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601-3630
Mailing Address - Country:US
Mailing Address - Phone:405-952-4470
Mailing Address - Fax:
Practice Address - Street 1:100 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:OK
Practice Address - Zip Code:73096-3001
Practice Address - Country:US
Practice Address - Phone:580-774-7176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK218079163WC1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1400XNursing Service ProvidersRegistered NurseCollege Health