Individual
MELINDA K PEMBERTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
901 HEARTLAND RD STE 3800, SAINT JOSEPH, MO 64506-6201
(816) 671-4800
(816) 233-4021
Mailing address
5301 FARAON ST STE 120, SAINT JOSEPH, MO 64506-3512
(816) 671-4800
(816) 233-4021
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
2000149865
MO
363LF0000X
Family Nurse Practitioner
Primary
AP143639
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1598080160
—
MO
05
—
200641200A
—
KS
01
—
P00847174
RR MEDICARE
MO
Enumeration date
04/07/2010
Last updated
08/23/2024
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