Healthcare Provider Details

I. General information

NPI: 1003151770
Provider Name (Legal Business Name): MELINDA STEGNER R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2012
Last Update Date: 12/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3445 SOUTH 291 HWY STE 300
INDEPENDENCE MO
64050
US

IV. Provider business mailing address

3445 SOUTH 291 HWY STE 300
INDEPENDENCE MO
64057
US

V. Phone/Fax

Practice location:
  • Phone: 816-795-1968
  • Fax:
Mailing address:
  • Phone: 816-795-1968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2001003796
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number2001003796
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number2001003796
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number2001003796
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code163WI0600X
TaxonomyInfection Control Registered Nurse
License Number2001003796
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: