Provider Demographics
NPI:1134451453
Name:BEAL, MELANIE ANN (FNP)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:ANN
Last Name:BEAL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:ANN
Other - Last Name:JESKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:8929 PARALLEL PKWY
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66112-1689
Mailing Address - Country:US
Mailing Address - Phone:913-596-4000
Mailing Address - Fax:
Practice Address - Street 1:8929 PARALLEL PKWY
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-1689
Practice Address - Country:US
Practice Address - Phone:913-596-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-11
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010004418363LF0000X
KS53-76353-032363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO540568508Medicaid
MO595956202Medicaid
MO1134451453Medicaid
43745011OtherBCBS
261320Medicare Oscar/Certification
P270000Medicare PIN
43745011OtherBCBS
P27000017Medicare PIN