Healthcare Provider Details

I. General information

NPI: 1992613848
Provider Name (Legal Business Name): MELANIE LYNNE JOHNSON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELANIE LYNNE MCCOLM FNP-BC

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 WILBUR
ROCK KS
67131-9041
US

IV. Provider business mailing address

204 WILBUR
ROCK KS
67131-9041
US

V. Phone/Fax

Practice location:
  • Phone: 620-606-0415
  • Fax:
Mailing address:
  • Phone: 620-606-0415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-86098-011
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: