MEDICARE: MARY KATHERINE MELTON CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367A00000X	Advanced Practice Midwife	2019003450	MO
2	367A00000X	Advanced Practice Midwife	2009038377	MO

General Provider Information

NPI Number	:	1649201013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY KATHERINE MELTON CNM

Provider Business Mailing Address
First Line	:	8380 N TULLIS AVE STE 300
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64158-5114
Country	:	US
Telephone Number	:	816-741-9122
Fax Number	:	816-841-9665

Provider Business Practice Location Address
First Line	:	8380 N TULLIS AVE STE 300
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64158-5114
Country	:	US
Telephone Number	:	816-741-9122
Fax Number	:	816-841-9665

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	04/21/2020

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