Provider Demographics
NPI:1417422411
Name:HALL, MELANIE
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W 16TH ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:KS
Mailing Address - Zip Code:67045-1064
Mailing Address - Country:US
Mailing Address - Phone:620-583-7451
Mailing Address - Fax:620-583-6702
Practice Address - Street 1:1174 E 120TH AVE N
Practice Address - Street 2:
Practice Address - City:BELLE PLAINE
Practice Address - State:KS
Practice Address - Zip Code:67013-7909
Practice Address - Country:US
Practice Address - Phone:316-644-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-05
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-78425-021363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily