Provider Demographics
NPI:1447941646
Name:SCOGGAN, MICHAEL (MSN, APRN, ACNPC-AG)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:SCOGGAN
Suffix:
Gender:M
Credentials:MSN, APRN, ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 GRAND PARK DR STE 311
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26105-4000
Mailing Address - Country:US
Mailing Address - Phone:304-865-5105
Mailing Address - Fax:
Practice Address - Street 1:418 GRAND PARK DR STE 311
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26105-4000
Practice Address - Country:US
Practice Address - Phone:304-865-5105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-17
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV116447363LA2100X, 363L00000X, 363LG0600X, 363LA2200X
OHAPRN.CNP.0033854363L00000X, 363LA2100X, 363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology