Healthcare Provider Details

I. General information

NPI: 1770184269
Provider Name (Legal Business Name): MELISSA BEAUREGARD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 LIVEWELL DR
KENNEBUNK ME
04043-6762
US

IV. Provider business mailing address

72 HIGH ST
KENNEBUNK ME
04043-6935
US

V. Phone/Fax

Practice location:
  • Phone: 207-467-8988
  • Fax: 207-467-8969
Mailing address:
  • Phone: 207-604-0534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP201251
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: