Provider Demographics
NPI:1114161528
Name:MELVIN, BROOK AILEEN
Entity Type:Individual
Prefix:
First Name:BROOK
Middle Name:AILEEN
Last Name:MELVIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BROOK
Other - Middle Name:
Other - Last Name:HILDWEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7341 W 133RD ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-4750
Mailing Address - Country:US
Mailing Address - Phone:913-297-7472
Mailing Address - Fax:833-314-0172
Practice Address - Street 1:7341 W 133RD ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-4750
Practice Address - Country:US
Practice Address - Phone:913-297-7472
Practice Address - Fax:833-314-0172
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004004978363LF0000X
KS46326363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily