Healthcare Provider Details

I. General information

NPI: 1689942914
Provider Name (Legal Business Name): MELINDA SUE GORNEY APRN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2011
Last Update Date: 05/17/2022
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10870 BENSON DR STE 2160
OVERLAND PARK KS
66210-1509
US

IV. Provider business mailing address

801 LOCUST ST
LA CROSSE KS
67548-9673
US

V. Phone/Fax

Practice location:
  • Phone: 833-357-3227
  • Fax: 855-299-2184
Mailing address:
  • Phone: 785-222-2564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5375403041
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: