Healthcare Provider Details

I. General information

NPI: 1063173383
Provider Name (Legal Business Name): MEGHAN K WACHTER PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2022
Last Update Date: 04/25/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

696 BULTMAN DR.
SUMTER SC
29150-2549
US

IV. Provider business mailing address

674 W LIBERTY ST
SUMTER SC
29150-4882
US

V. Phone/Fax

Practice location:
  • Phone: 803-848-0500
  • Fax: 803-848-0700
Mailing address:
  • Phone: 803-773-5227
  • Fax: 803-757-4010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number25691
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: