Healthcare Provider Details

I. General information

NPI: 1407500440
Provider Name (Legal Business Name): MELANIE R SMITH APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 N RIVERSIDE RD
SAINT JOSEPH MO
64507-2518
US

IV. Provider business mailing address

5301 FARAON ST STE 120
SAINT JOSEPH MO
64506-3512
US

V. Phone/Fax

Practice location:
  • Phone: 816-271-1221
  • Fax: 816-279-7794
Mailing address:
  • Phone: 816-271-1241
  • Fax: 816-279-7794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2022004503
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: