Provider Demographics
NPI:1083724603
Name:PARKHURST, MELISSA L (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:L
Last Name:PARKHURST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:MELISSA
Other - Middle Name:L
Other - Last Name:ANNIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3901 RAINBOW BLVD.
Mailing Address - Street 2:4070 DELP, MS 4017 KANSAS UNIVERSITY PHYSICIANS, INC.
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160
Mailing Address - Country:US
Mailing Address - Phone:913-588-2501
Mailing Address - Fax:
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:6040 DELP, MS 1020 DIVISION OF GENERAL AND GERIATRIC
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160
Practice Address - Country:US
Practice Address - Phone:913-588-6005
Practice Address - Fax:913-588-3877
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-27117207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100340440BMedicaid
KS634741OtherFIRSTGUARD
MO208406306Medicaid
MO29757027OtherBCBS KANSAS CITY
MO208406306Medicaid
KS634741OtherFIRSTGUARD
H06990Medicare UPIN