Individual provider Active NPI

Melanie Nicole Reynolds, CRNP

  • Nurse Practitioner
  • Columbia, MD
National Provider Identifier
1396053906
Registry record updated Sep 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
R185462 Issued in MD
Practice address
10630 Little Patuxent Pkwy Ste 314
Columbia, MD 21044-6216
Phone
(443) 364-8262
NPI assigned
Sep 16, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 15, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X R185462 MD Primary

Addresses

Primary practice location

10630 Little Patuxent Pkwy Ste 314
Columbia, MD 21044-6216

Mailing address

10630 Little Patuxent Pkwy Ste 314
Columbia, MD 21044-6216
Phone (443) 364-8262

Other identifiers 2

IdentifierTypeStateIssuer
060755100MedicaidDC
789006100MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260604002737 VA Practitioner - Nurse Practitioner 2961681986 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

12900 Park Plaza Dr
Suite 150
Cerritos, CA 90703-9329

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Care LLC Nurse Practitioner CurrentSince Aug 28, 2025 Accepting new patients
Cancer Care Network of South Texas PA Past Accepting new patients
Cancer Care Network of South Texas PA Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: mreynolds35119@carelonhealth.direct-ci.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1284595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757894400000",
    "number": "1396053906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10630 LITTLE PATUXENT PKWY STE 314",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210446216",
            "telephone_number": "443-364-8262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10630 LITTLE PATUXENT PKWY STE 314",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210446216",
            "telephone_number": "443-364-8262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "MELANIE",
        "middle_name": "NICOLE",
        "name_prefix": "Mrs.",
        "credential": "CRNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-09-16",
        "last_updated": "2025-09-15",
        "certification_date": "2025-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MD",
            "license": "R185462",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060755100",
            "state": "DC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "789006100",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, MD

Sources for this page

Verify at the official NPI Registry.