Provider Demographics
NPI:1013301092
Name:WAY, MEGAN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:
Last Name:WAY
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 1:320 JAKE ALEXANDER BLVD W STE 103
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28147-1443
Mailing Address - Country:US
Mailing Address - Phone:704-797-0065
Mailing Address - Fax:704-797-0067
Practice Address - Street 1:320 JAKE ALEXANDER BLVD W STE 103
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147-1443
Practice Address - Country:US
Practice Address - Phone:704-797-0065
Practice Address - Fax:704-797-0067
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001005659363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC101-330-1092Medicaid