Healthcare Provider Details

I. General information

NPI: 1255979621
Provider Name (Legal Business Name): MELISSA NICOLE EBERT APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2019
Last Update Date: 10/27/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13101 STATE LINE RD
KANSAS CITY MO
64145-1650
US

IV. Provider business mailing address

330 NE BARRY RD
KANSAS CITY MO
64155-2724
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number2006007880
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-79203-072
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2020001585
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: