Provider Demographics
NPI:1679655013
Name:CERRA, MELINDA L (ARNP)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:L
Last Name:CERRA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 931288
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64193-0001
Mailing Address - Country:US
Mailing Address - Phone:913-789-4155
Mailing Address - Fax:
Practice Address - Street 1:7301 E FRONTAGE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66204-1654
Practice Address - Country:US
Practice Address - Phone:913-384-4040
Practice Address - Fax:913-384-4093
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45187363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P40183Medicare UPIN