Individual provider Active NPI

Melissa Anne Wilson, FNP-C

  • Family Nurse Practitioner
  • Bedford, NH
National Provider Identifier
1649822958
Registry record updated Jul 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
076746-23 Issued in NH
Practice address
8 Commerce Dr Ste 101
Bedford, NH 03110-6946
Phone
(978) 758-8973
NPI assigned
Jul 16, 2019
Last updated
Jul 10, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN275865 MA
Family Nurse Practitioner 363LF0000X 076746-23 NH Primary

Addresses

Primary practice location

8 Commerce Dr Ste 101
Bedford, NH 03110-6946

Mailing address

3 Waterville Dr
Merrimack, NH 03054-2609
Phone (978) 758-8973

Other practice location 1

3 Waterville Dr
Merrimack, NH 03054-2609
Phone (978) 758-8973

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH, MA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20230526000832 NH Practitioner - Nurse Practitioner 0345607842 Reassigns benefits to 1 organization
I20230630001722 MA Practitioner - Nurse Practitioner 0345607842 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Avenir Ventures LLCGroup PAC ID 1153593017, 33 clinicians

Practice addresses (Care Compare)

8 Commerce Dr
Suite 101
Bedford, NH 03110-6946
Phone (877) 202-2869

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
RN275865MAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Avenir Ventures, L.L.C. CurrentSince Jan 12, 2023 Accepting new patients

Locations

3854 American Way
Ste A
Baton Rouge, LA 70816
Phone (225) 299-3253

8 Commerce Dr
Ste 101
Bedford, NH 03110
Phone (603) 421-0414

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1563235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688947200000",
    "number": "1649822958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 WATERVILLE DR",
            "city": "MERRIMACK",
            "state": "NH",
            "postal_code": "030542609",
            "telephone_number": "978-758-8973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8 COMMERCE DR STE 101",
            "city": "BEDFORD",
            "state": "NH",
            "postal_code": "031106946",
            "telephone_number": "978-758-8973"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3 Waterville Dr",
            "address_purpose": "LOCATION",
            "city": "Merrimack",
            "state": "NH",
            "postal_code": "030542609",
            "country_code": "US",
            "telephone_number": "978-758-8973",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "MELISSA",
        "middle_name": "ANNE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-16",
        "last_updated": "2023-07-10",
        "certification_date": "2023-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MA",
            "license": "RN275865",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NH",
            "license": "076746-23",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bedford, NH

Sources for this page

Verify at the official NPI Registry.