Provider Demographics
NPI:1841609617
Name:GREESON, MELISSA (PA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:GREESON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:BORTHWICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:TRIBUNE
Mailing Address - State:KS
Mailing Address - Zip Code:67879-0640
Mailing Address - Country:US
Mailing Address - Phone:620-376-4251
Mailing Address - Fax:620-376-2772
Practice Address - Street 1:321 E HARPER ST
Practice Address - Street 2:
Practice Address - City:TRIBUNE
Practice Address - State:KS
Practice Address - Zip Code:67879-7708
Practice Address - Country:US
Practice Address - Phone:620-376-4251
Practice Address - Fax:620-376-2772
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01715363AM0700X
APPLIED FOR363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant