Provider Demographics
NPI:1164072534
Name:WHITE, MELISSA DAWN (APRN-CNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:DAWN
Last Name:WHITE
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:DAWN
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1239
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-1239
Mailing Address - Country:US
Mailing Address - Phone:573-248-5403
Mailing Address - Fax:573-248-5419
Practice Address - Street 1:211 S 3RD ST
Practice Address - Street 2:
Practice Address - City:LOUISIANA
Practice Address - State:MO
Practice Address - Zip Code:63353-2000
Practice Address - Country:US
Practice Address - Phone:573-754-5555
Practice Address - Fax:573-754-5932
Is Sole Proprietor?:No
Enumeration Date:2019-09-17
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR0119396363L00000X
OK119396363LA2200X
MO2022025341363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health