Provider Demographics
NPI:1689557852
Name:JOHNSON, MEAGEN KRYSTINE
Entity type:Individual
Prefix:
First Name:MEAGEN
Middle Name:KRYSTINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:591 BENDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25314-1512
Mailing Address - Country:US
Mailing Address - Phone:304-945-4764
Mailing Address - Fax:
Practice Address - Street 1:85 DONOHOE DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-8887
Practice Address - Country:US
Practice Address - Phone:304-399-3310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program