Provider Demographics
NPI:1982383956
Name:CROWNOVER, MELISSA CAREY (AGPCNP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:CAREY
Last Name:CROWNOVER
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 DEEPWOODS CT
Mailing Address - Street 2:
Mailing Address - City:LINN VALLEY
Mailing Address - State:KS
Mailing Address - Zip Code:66040-5212
Mailing Address - Country:US
Mailing Address - Phone:913-259-8502
Mailing Address - Fax:
Practice Address - Street 1:17 DEEPWOODS CT
Practice Address - Street 2:
Practice Address - City:LINN VALLEY
Practice Address - State:KS
Practice Address - Zip Code:66040-5212
Practice Address - Country:US
Practice Address - Phone:913-259-8502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS79546363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology