Healthcare Provider Details

I. General information

NPI: 1629207931
Provider Name (Legal Business Name): MELVIN KILE VINEY JR. APRN-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2009
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 W BRAMLEY ST
JETMORE KS
67854-9320
US

IV. Provider business mailing address

373 E 10TH AVE
SPRINGFIELD CO
81073-1622
US

V. Phone/Fax

Practice location:
  • Phone: 620-393-0010
  • Fax:
Mailing address:
  • Phone: 719-523-2125
  • Fax: 719-523-4290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0993946
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-76305-032
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: