=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972586865
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELINDA S WELLS ARNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/23/2005
-----------------------------------------------------
Last Update Date | 04/28/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2090 W DARTMOUTH ST
-----------------------------------------------------
City | OLATHE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66061-6869
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-856-8300
-----------------------------------------------------
Fax | 913-856-8711
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15607 W 125TH ST
-----------------------------------------------------
City | OLATHE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66062-4991
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-483-3333
-----------------------------------------------------
Fax | 785-483-4859
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 53-45053
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------