Provider Demographics
NPI:1114360435
Name:KEITHLY, MELINA (DO)
Entity Type:Individual
Prefix:
First Name:MELINA
Middle Name:
Last Name:KEITHLY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MELINA
Other - Middle Name:
Other - Last Name:LETHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 716
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66201-0716
Mailing Address - Country:US
Mailing Address - Phone:913-642-4900
Mailing Address - Fax:913-381-0979
Practice Address - Street 1:20333 W 151ST ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-5350
Practice Address - Country:US
Practice Address - Phone:913-791-4357
Practice Address - Fax:913-791-4435
Is Sole Proprietor?:No
Enumeration Date:2013-04-17
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0537842207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine