Provider Demographics
NPI:1689154965
Name:LAUGHLIN WALLER, MELANIE (APRN, NP-C)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:LAUGHLIN WALLER
Suffix:
Gender:F
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2741 NE MCBAINE DR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-7880
Mailing Address - Country:US
Mailing Address - Phone:816-554-2600
Mailing Address - Fax:
Practice Address - Street 1:2741 NE MCBAINE DR
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-7880
Practice Address - Country:US
Practice Address - Phone:816-554-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK105464363LF0000X
MO2024012232363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily