Healthcare Provider Details

I. General information

NPI: 1811802168
Provider Name (Legal Business Name): MELISSA JOANN MAHONEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 HICKORY ST APT 2
WARRENSBURG MO
64093-1270
US

IV. Provider business mailing address

804 HICKORY ST APT 2
WARRENSBURG MO
64093-1270
US

V. Phone/Fax

Practice location:
  • Phone: 561-255-8287
  • Fax:
Mailing address:
  • Phone: 561-255-8287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2003005262
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: