Melanie Renee Bouldwate

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

5218053 Issued in FL

Practice address

500 Sandy LN Apt 201
Acworth, GA 30102-1497

Phone

(121) 575-6190

NPI assigned

Dec 20, 2022

Last updated

Dec 20, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1671494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671494400000",
    "number": "1033821152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 SANDY LN APT 201",
            "city": "ACWORTH",
            "state": "GA",
            "postal_code": "301021497",
            "telephone_number": "121-575-6190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 SANDY LN APT 201",
            "city": "ACWORTH",
            "state": "GA",
            "postal_code": "301021497",
            "telephone_number": "121-575-6190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULDWATE",
        "first_name": "MELANIE",
        "middle_name": "RENEE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-12-20",
        "last_updated": "2022-12-20",
        "certification_date": "2022-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "FL",
            "license": "5218053",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christine Bollinger, D.C.
• Mary Elizabeth Gill Bonds, OTR/L
• Sheryl Booth
• Judith Borduin
• Lindsay Marcelle Bouchard, OTR/L
• Susie Boustead, MS CCC-SLP
• Sarah Boyles, DMD
• Braces Braces LLC
• Larry L. Braden, R.PH.
• Jessica Nicole Bradford, PTA

• Licensed Practical Nurse in Acworth, GA
• Providers in Acworth, GA by specialty
• Licensed Practical Nurse in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.