Healthcare Provider Details

I. General information

NPI: 1912358565
Provider Name (Legal Business Name): MELEAH VAUGHAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELEAH SHIELDS

II. Dates (important events)

Enumeration Date: 06/24/2016
Last Update Date: 01/26/2021
Certification Date: 01/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9229 WARD PKWY STE 380
KANSAS CITY MO
64114-5471
US

IV. Provider business mailing address

619 E MASON ST SUITE 4P57
SPRINGFIELD IL
62701-1034
US

V. Phone/Fax

Practice location:
  • Phone: 816-319-4785
  • Fax:
Mailing address:
  • Phone: 217-788-0706
  • Fax: 217-525-2535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209014382
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberMO-2013039537
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: