Provider Demographics
NPI:1538816160
Name:SALMON, MELAINA
Entity type:Individual
Prefix:
First Name:MELAINA
Middle Name:
Last Name:SALMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 W 43RD ST APT 1024
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3048
Mailing Address - Country:US
Mailing Address - Phone:816-258-9353
Mailing Address - Fax:
Practice Address - Street 1:907 E LINCOLN LN
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:KS
Practice Address - Zip Code:66030-3701
Practice Address - Country:US
Practice Address - Phone:913-856-1369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-03
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023038574363A00000X
HIAMD-1272363A00000X
KS15-02829363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2023038574OtherSTATE LICENSE
HIAMD-1272OtherSTATE LICENSE
KS15-02829OtherSTATE LICENSE