Healthcare Provider Details

I. General information

NPI: 1225796550
Provider Name (Legal Business Name): MELANIE RENEE HERNANDEZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELANIE RENEE WILSON

II. Dates (important events)

Enumeration Date: 12/03/2021
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 SW 10TH AVE
TOPEKA KS
66604-1301
US

IV. Provider business mailing address

1500 SW 10TH AVE
TOPEKA KS
66604-1301
US

V. Phone/Fax

Practice location:
  • Phone: 785-354-6440
  • Fax:
Mailing address:
  • Phone: 785-354-4664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number53-82593
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number2025013112
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number41779
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number11045939
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1397315111
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: