Provider Demographics
NPI:1649553777
Name:STROH, MELISSA (PA-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:STROH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:KIOWA
Mailing Address - State:KS
Mailing Address - Zip Code:67070-1825
Mailing Address - Country:US
Mailing Address - Phone:620-825-4131
Mailing Address - Fax:
Practice Address - Street 1:1002 S 4TH ST
Practice Address - Street 2:
Practice Address - City:KIOWA
Practice Address - State:KS
Practice Address - Zip Code:67070-1825
Practice Address - Country:US
Practice Address - Phone:620-825-4131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01642363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant