Provider Demographics
NPI:1114245404
Name:KOCOUR, MELISSA ANN (RPA)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ANN
Last Name:KOCOUR
Suffix:
Gender:F
Credentials:RPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 RAVEN HILL DRIVE
Mailing Address - Street 2:
Mailing Address - City:ATCHISON
Mailing Address - State:KS
Mailing Address - Zip Code:66002
Mailing Address - Country:US
Mailing Address - Phone:913-367-2131
Mailing Address - Fax:913-674-2023
Practice Address - Street 1:800 RAVEN HILL DRIVE
Practice Address - Street 2:
Practice Address - City:ATCHISON
Practice Address - State:KS
Practice Address - Zip Code:66002
Practice Address - Country:US
Practice Address - Phone:913-367-2131
Practice Address - Fax:913-674-2023
Is Sole Proprietor?:No
Enumeration Date:2010-05-11
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS10KS1404243U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS10KS1404OtherCBRPA