Provider Demographics
NPI:1932868809
Name:MATZEK, MELISSA AMBER (APRN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:AMBER
Last Name:MATZEK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3109 S 53RD TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66106-3211
Mailing Address - Country:US
Mailing Address - Phone:913-378-6345
Mailing Address - Fax:
Practice Address - Street 1:7450 KESSLER ST STE 205
Practice Address - Street 2:
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66204-2553
Practice Address - Country:US
Practice Address - Phone:913-632-9810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-79624-012363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner