Healthcare Provider Details

I. General information

NPI: 1558663609
Provider Name (Legal Business Name): MELISSA KAY LOOMIS DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2010
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date: 06/04/2019
Reactivation Date: 06/10/2019

III. Provider practice location address

721 E 97TH ST
KANSAS CITY MO
64131-3244
US

IV. Provider business mailing address

721 E 97TH ST
KANSAS CITY MO
64131-3244
US

V. Phone/Fax

Practice location:
  • Phone: 816-835-4175
  • Fax:
Mailing address:
  • Phone: 816-835-4175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2010039079
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number75864
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number264520
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA154074
License Number StateIA
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number202002288NP-PP
License Number StateOR
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-75864-101
License Number StateKS
# 7
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP70044959
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: