Healthcare Provider Details

I. General information

NPI: 1730706243
Provider Name (Legal Business Name): MELISSA ANNE MANN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2020
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 S OSTEOPATHY AVE ATTN DME OFFICE
KIRKSVILLE MO
63501-6401
US

IV. Provider business mailing address

315 S OSTEOPATHY AVE ATTN DME OFFICE
KIRKSVILLE MO
63501-6401
US

V. Phone/Fax

Practice location:
  • Phone: 515-979-8442
  • Fax:
Mailing address:
  • Phone: 660-785-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2020019341
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number58.033272
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: