Provider Demographics
NPI:1437361979
Name:CONROY, MELISSA JANE (DO)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:JANE
Last Name:CONROY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:600 CAISSON HILL RD
Mailing Address - Street 2:
Mailing Address - City:FT RILEY
Mailing Address - State:KS
Mailing Address - Zip Code:66442-7037
Mailing Address - Country:US
Mailing Address - Phone:785-239-7613
Mailing Address - Fax:785-239-7121
Practice Address - Street 1:600 CAISSON HILL RD
Practice Address - Street 2:
Practice Address - City:FT RILEY
Practice Address - State:KS
Practice Address - Zip Code:66442-7037
Practice Address - Country:US
Practice Address - Phone:785-239-7613
Practice Address - Fax:785-239-7121
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-32785208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200543160AMedicaid