Provider Demographics
NPI:1093760530
Name:ALGRIM, MELANIE ANN (ARNP)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:ANN
Last Name:ALGRIM
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2923 KRIS PL
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-7334
Mailing Address - Country:US
Mailing Address - Phone:620-275-4394
Mailing Address - Fax:
Practice Address - Street 1:911 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-5561
Practice Address - Country:US
Practice Address - Phone:620-276-8201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45367363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS171813Medicare PIN
KS171815Medicare PIN
KS171814Medicare PIN
KS171810Medicare PIN