MEDICARE: MEGHAN K WACHTER PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	25691	SC

General Provider Information

NPI Number	:	1063173383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGHAN K WACHTER PMHNP

Provider Business Mailing Address
First Line	:	674 W LIBERTY ST
Second Line	:
City	:	SUMTER
State	:	SC
Zip	:	29150-4882
Country	:	US
Telephone Number	:	803-773-5227
Fax Number	:	803-757-4010

Provider Business Practice Location Address
First Line	:	696 BULTMAN DR.
Second Line	:
City	:	SUMTER
State	:	SC
Zip	:	29150-2549
Country	:	US
Telephone Number	:	803-848-0500
Fax Number	:	803-848-0700

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2022
Last Update Date	:	04/25/2023

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