Healthcare Provider Details

I. General information

NPI: 1871197996
Provider Name (Legal Business Name): MELISSA LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W 19TH TER
KANSAS CITY MO
64108-2026
US

IV. Provider business mailing address

8015 FREEMAN AVENUE
KANSAS CITY KS
66112
US

V. Phone/Fax

Practice location:
  • Phone: 816-404-5790
  • Fax: 816-404-0320
Mailing address:
  • Phone: 913-378-3030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number2011017882
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: