Healthcare Provider Details

I. General information

NPI: 1164072534
Provider Name (Legal Business Name): MELISSA DAWN WHITE APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA DAWN MEYER

II. Dates (important events)

Enumeration Date: 09/17/2019
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 S 3RD ST
LOUISIANA MO
63353-2000
US

IV. Provider business mailing address

PO BOX 1239
HANNIBAL MO
63401-1239
US

V. Phone/Fax

Practice location:
  • Phone: 573-754-5555
  • Fax: 573-754-5932
Mailing address:
  • Phone: 573-248-5403
  • Fax: 573-248-5419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR0119396
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number119396
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number2022025341
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: