Basic Information
| Provider Information | |||||||||
| NPI: | 1831647262 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOBLEY | ||||||||
| FirstName: | MELANIE | ||||||||
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| Credential: | AGPCNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5 | ||||||||
| Address2: | |||||||||
| City: | DONIPHAN | ||||||||
| State: | MO | ||||||||
| PostalCode: | 639350005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5739964017 | ||||||||
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| Practice Location | |||||||||
| Address1: | 210 NE TUDOR RD | ||||||||
| Address2: | |||||||||
| City: | LEES SUMMIT | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640865696 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8882563814 | ||||||||
| FaxNumber: | 8882569054 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2016 | ||||||||
| LastUpdateDate: | 09/14/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | N | Other Service Providers | Specialist | 363LG0600X | 2016029751 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
No ID Information.