Provider Demographics
NPI:1992179741
Name:MILLER, MELANIE (APRN- BC)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:APRN- BC
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 512
Mailing Address - Street 2:
Mailing Address - City:BONNER SPRINGS
Mailing Address - State:KS
Mailing Address - Zip Code:66012-0512
Mailing Address - Country:US
Mailing Address - Phone:877-942-8808
Mailing Address - Fax:877-791-9808
Practice Address - Street 1:128 OAK ST STE C
Practice Address - Street 2:
Practice Address - City:BONNER SPRINGS
Practice Address - State:KS
Practice Address - Zip Code:66012-1046
Practice Address - Country:US
Practice Address - Phone:877-942-8808
Practice Address - Fax:877-791-9808
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-17
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5376881072363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner