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General NPI Number Information
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NPI Number | 1720610744
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Entity Type | Individual
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Provider Name | MELISSA MARIE HILDEBRANDT FNP-C
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Gender | Female
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Dates
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Enumeration Date | 02/07/2020
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Last Update Date | 02/16/2021
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Provider Practice Location Address
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Address Line | 1100 NW SOUTH OUTER RD STE 200
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City | BLUE SPRINGS
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State | MO
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Zip | 64015-3069
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Country | US
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Telephone | 888-256-3814
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Fax | 888-256-9054
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Provider Business Mailing Address
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Address Line | 1100 NW SOUTH OUTER RD STE 200
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City | BLUE SPRINGS
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State | MO
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Zip | 64015-3069
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Country | US
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Telephone | 888-256-3814
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Fax | 888-256-9054
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | M2020011703
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 53-79235-122
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License Number State | KS
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