Provider Demographics
NPI:1528284593
Name:SMITH, MELISSA S (NP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:S
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5247 W 129TH TER
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66209-3401
Mailing Address - Country:US
Mailing Address - Phone:913-685-3014
Mailing Address - Fax:
Practice Address - Street 1:UMKC STUDENT HEALTH & WELLNESS SERVICE
Practice Address - Street 2:4825 TROOST AVENUE SUITE 115
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64110-2499
Practice Address - Country:US
Practice Address - Phone:816-235-5694
Practice Address - Fax:816-235-1701
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO131213363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily