Melynda Kaye Wallace, CRNA, APRN

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

040072-23-11 Issued in NH

Practice address

151 Route 10 N Unit 2
Grantham, NH 03753-3621

Phone

(603) 309-3902

Fax

(603) 843-8176

NPI assigned

Jan 6, 2006

Last updated

Apr 22, 2024By 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 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: No
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Icon Anesthesia Services of New England LLCGroup PAC ID 2668732041, 21 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/ICDBDD/Endpoint/ICDBDD

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.

• Icon Anesthesia Services of New England LLC

  • Anesthesiology Physician
  • Middleton, MA
  • NPI 1629583323

  NH

  Medicare reassignment Care Compare group NPD
• Faodail Pain Management, PLLC

  dba Full Life Pain and Depression Center

  • Pain Medicine Physician
  • Grantham, NH
  • NPI 1114524824
  Medicare reassignment Authorized official
• Concord Eye Surgery LLC

  • Ambulatory Surgical Clinic/Center
  • Concord, NH
  • NPI 1437138500
  Medicare reassignment NPD
• Medstream Anesthesia PLLC

  • Anesthesiology Physician
  • Richardson, TX
  • NPI 1649616160

  NH, Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Dynamic Anesthesia, PLLC

  • Certified Registered Nurse Anesthetist
  • Center Conway, NH
  • NPI 1952596751

  Nurse Anesthetist, Certified Registered

  NPD (past)

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

{
    "created_epoch": "1136505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713744000000",
    "number": "1881672137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 ROUTE 10 N UNIT 2",
            "city": "GRANTHAM",
            "state": "NH",
            "postal_code": "037533621",
            "telephone_number": "603-309-3902",
            "fax_number": "603-843-8176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 ROUTE 10 N UNIT 2",
            "city": "GRANTHAM",
            "state": "NH",
            "postal_code": "037533621",
            "telephone_number": "603-309-3902",
            "fax_number": "603-843-8176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "MELYNDA",
        "middle_name": "KAYE",
        "name_prefix": "Ms.",
        "credential": "CRNA, APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-01-06",
        "last_updated": "2024-04-22",
        "certification_date": "2024-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NH",
            "license": "040072-23-11",
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NH",
            "license": "040072-23",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1008569",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1008569",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Schmidt Therapies, LLC
• Spark Therapies LLC
• Sproutsters Inc. (Sproutsters)
• Owen Tanada Tabelisma, OTR/L
• Jennifer L Taylor, APRN, PMHNP
• James Whedon
• York Psychiatry PLLC

• Nurse Practitioner in Grantham, NH
• Providers in Grantham, NH by specialty
• Nurse Practitioner in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.