Healthcare Provider Details

I. General information

NPI: 1912178575
Provider Name (Legal Business Name): MELINDA HEUTINCK ANP-C, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2008
Last Update Date: 03/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 W 109TH ST SUITE 100
OVERLAND PARK KS
66211-1303
US

IV. Provider business mailing address

4401 W 109TH ST SUITE 200
OVERLAND PARK KS
66211-1303
US

V. Phone/Fax

Practice location:
  • Phone: 913-345-1400
  • Fax:
Mailing address:
  • Phone: 913-312-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number146726
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: