Healthcare Provider Details

I. General information

NPI: 1912178575
Provider Name (Legal Business Name): MELINDA HEUTINCK ANP-C, PMHNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2008
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1504 NE 96TH ST STE A
LIBERTY MO
64068-1351
US

IV. Provider business mailing address

1504 NE 96TH ST STE A
LIBERTY MO
64068-1351
US

V. Phone/Fax

Practice location:
  • Phone: 816-415-2233
  • Fax: 816-415-2218
Mailing address:
  • Phone: 816-415-2233
  • Fax: 816-415-2218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number146726
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number146726
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: