Provider Demographics
NPI:1982047064
Name:TUNGATE, MELISSA MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIE
Last Name:TUNGATE
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 1:310 S HILLSIDE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-2129
Mailing Address - Country:US
Mailing Address - Phone:316-264-3505
Mailing Address - Fax:316-264-0908
Practice Address - Street 1:310 S HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-2129
Practice Address - Country:US
Practice Address - Phone:316-264-3505
Practice Address - Fax:316-264-0908
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-75896-102363LA2100X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology