Healthcare Provider Details

I. General information

NPI: 1891604666
Provider Name (Legal Business Name): MELISSA ROY PRESTEGARD RT (R)(MR)(CT)(M)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2026
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 S 4TH ST
LEAVENWORTH KS
66048-5085
US

IV. Provider business mailing address

3550 S 4TH ST
LEAVENWORTH KS
66048-5085
US

V. Phone/Fax

Practice location:
  • Phone: 913-680-6297
  • Fax: 913-680-6408
Mailing address:
  • Phone: 913-680-6297
  • Fax: 913-680-6408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number22-03486
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: