Provider Demographics
NPI:1003607185
Name:LANE, MELISSA M (CPS)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:M
Last Name:LANE
Suffix:
Gender:F
Credentials:CPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 N HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MO
Mailing Address - Zip Code:64720-8319
Mailing Address - Country:US
Mailing Address - Phone:660-464-0884
Mailing Address - Fax:
Practice Address - Street 1:616 N HOUSTON ST
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MO
Practice Address - Zip Code:64720-8319
Practice Address - Country:US
Practice Address - Phone:660-464-0884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO17871175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist