Provider Demographics
NPI:1912178575
Name:HEUTINCK, MELINDA (ANP-C, ARNP)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:HEUTINCK
Suffix:
Gender:F
Credentials:ANP-C, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 W 109TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1303
Mailing Address - Country:US
Mailing Address - Phone:913-312-5100
Mailing Address - Fax:
Practice Address - Street 1:4401 W 109TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1303
Practice Address - Country:US
Practice Address - Phone:913-345-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-21
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO146726363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO09841048OtherBCBS KCMO
MO06215024OtherBCBS KCMO GROUP
MO146726OtherMO STATE BOARD OF NURSING
KS0110035OtherBCBS KS GROUP