Provider Demographics
NPI:1801630900
Name:CADWALADER, MELISSA L (APRN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:L
Last Name:CADWALADER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:L
Other - Last Name:STANNARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:1555 NE RICE RD
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-5849
Mailing Address - Country:US
Mailing Address - Phone:816-347-3069
Mailing Address - Fax:
Practice Address - Street 1:3211 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64109-2073
Practice Address - Country:US
Practice Address - Phone:816-966-0900
Practice Address - Fax:816-554-4370
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024024280363L00000X, 363LP0808X, 363LP0808X
KS53-83395-061363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner