Provider Demographics
NPI:1780197822
Name:MENGELT, BETH ANN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:ANN
Last Name:MENGELT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MISS
Other - First Name:BETH
Other - Middle Name:ANN
Other - Last Name:WALDROP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1602 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-9312
Mailing Address - Country:US
Mailing Address - Phone:928-978-2207
Mailing Address - Fax:
Practice Address - Street 1:1602 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-9312
Practice Address - Country:US
Practice Address - Phone:928-978-2207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-12
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21423363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1780197822Medicaid