Provider Demographics
NPI:1558663609
Name:LOOMIS, MELISSA KAY (DNP)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:KAY
Last Name:LOOMIS
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5417 JOHNSON DR
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66205-2912
Mailing Address - Country:US
Mailing Address - Phone:913-261-9479
Mailing Address - Fax:
Practice Address - Street 1:5417 JOHNSON DR
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66205-2912
Practice Address - Country:US
Practice Address - Phone:913-261-9479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-23
Last Update Date:2023-02-07
Deactivation Date:2019-06-04
Deactivation Code:
Reactivation Date:2019-06-10
Provider Licenses
StateLicense IDTaxonomies
IAA154074363LF0000X
KS75864363LF0000X
MO2010039079363LF0000X
KS53-75864-101363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
88OtherNONE