Healthcare Provider Details

I. General information

NPI: 1801630900
Provider Name (Legal Business Name): MELISSA L STANNARD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA L CADWALADER APRN

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 W 94TH TER
PRAIRIE VILLAGE KS
66207-2504
US

IV. Provider business mailing address

1312 NE HORIZON DR
LEES SUMMIT MO
64086-6828
US

V. Phone/Fax

Practice location:
  • Phone: 913-381-8555
  • Fax: 913-677-2112
Mailing address:
  • Phone: 912-675-5362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2024024280
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2024024280
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number53-83395-061
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: