Provider Demographics
NPI:1295100105
Name:OTT, MELISSA (NP-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:OTT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 W 47TH PL
Mailing Address - Street 2:SUITE 400
Mailing Address - City:WESTWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66205-1815
Mailing Address - Country:US
Mailing Address - Phone:913-261-6164
Mailing Address - Fax:913-261-6464
Practice Address - Street 1:1900 W 47TH PL
Practice Address - Street 2:SUITE 400
Practice Address - City:WESTWOOD
Practice Address - State:KS
Practice Address - Zip Code:66205-1815
Practice Address - Country:US
Practice Address - Phone:913-261-6164
Practice Address - Fax:913-261-6464
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-77050-052363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily