Healthcare Provider Details

I. General information

NPI: 1306611413
Provider Name (Legal Business Name): MELANIE ALYSSIA GRAY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2023
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 SW GAGE BLVD STE 100
TOPEKA KS
66604-2283
US

IV. Provider business mailing address

1111 SW GAGE BLVD STE 100
TOPEKA KS
66604-2283
US

V. Phone/Fax

Practice location:
  • Phone: 785-329-6282
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3-001656
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9539287
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11031234
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number53-84002-052
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: