Provider Demographics
NPI:1962144402
Name:HAVERKAMP, MELISSA ANN (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:HAVERKAMP
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 N ROCK RD STE 350
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2276
Mailing Address - Country:US
Mailing Address - Phone:316-665-7165
Mailing Address - Fax:
Practice Address - Street 1:240 N ROCK RD STE 350
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2276
Practice Address - Country:US
Practice Address - Phone:316-665-7165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-13
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS81097363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily