MEDICARE: MEGHAN HEAD NP

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	363L00000X	Nurse Practitioner	23511	SC
2	207Q00000X	Family Medicine Physician	23511	SC
3	363LF0000X	Family Nurse Practitioner	23511	SC

General Provider Information

NPI Number	:	1477150340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGHAN HEAD NP

Provider Business Mailing Address
First Line	:	4975 LACROSS RD STE 200B
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-6531
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1220 SUMNER AVE
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-3822
Country	:	US
Telephone Number	:	843-225-1115
Fax Number	:

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

Provider Enumeration Date	:	10/05/2020
Last Update Date	:	05/08/2025

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Directions to “ MEGHAN HEAD NP” Practice Location

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