Healthcare Provider Details

I. General information

NPI: 1801346564
Provider Name (Legal Business Name): MELISSA SUSANNE WILLIAMSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2016
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26136 US HIGHWAY 59
FAIRFAX MO
64446-9105
US

IV. Provider business mailing address

26136 US HIGHWAY 59
FAIRFAX MO
64446-9105
US

V. Phone/Fax

Practice location:
  • Phone: 660-686-2211
  • Fax: 660-686-2799
Mailing address:
  • Phone: 660-686-2211
  • Fax: 660-686-2799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2016034321
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: