Provider Demographics
NPI:1053978007
Name:RADCLIFF, MEGAN (FNP, PMHNP)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:RADCLIFF
Suffix:
Gender:F
Credentials:FNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 36TH ST
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26104-1942
Mailing Address - Country:US
Mailing Address - Phone:304-944-9346
Mailing Address - Fax:304-944-3054
Practice Address - Street 1:1512 36TH ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26104-1942
Practice Address - Country:US
Practice Address - Phone:304-944-9346
Practice Address - Fax:304-944-3054
Is Sole Proprietor?:No
Enumeration Date:2019-05-24
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV103131363LF0000X
WV2022140757363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV004276177OtherBCBS
WV1053978007Medicaid