=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417222829
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELISSA LYNNE HEGEDUS PA-C, MPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2012
-----------------------------------------------------
Last Update Date | 10/19/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2090 W DARTMOUTH ST
-----------------------------------------------------
City | OLATHE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66061-5002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-356-8300
-----------------------------------------------------
Fax | 913-356-8711
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2090 W DARTMOUTH ST
-----------------------------------------------------
City | OLATHE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66061-5002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-356-8300
-----------------------------------------------------
Fax | 913-356-8711
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 018542
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 15-02049
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------