NPI |
1386351138 |
The State code in the location of the provider
being identified. |
Entity Type Code |
1 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Last Name Legal Name |
VERTIN |
The last name of the provider. If the provider is an individual, this is the legal name. |
Provider First Name |
MELISSA |
The first name of the provider, if the provider
is an individual. |
Provider Middle Name |
ANN |
The date the provider was assigned a unique identifier (assigned an NPI). |
Provider First Line Business Practice Location Address |
2848 TENNESSEE RD |
The date that a record was last updated or changed. |
Provider Business Practice Location Address City Name |
OTTAWA |
The code designating the provider’s gender if the provider is a person. |
Provider Business Practice Location Address State Name |
KS |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Provider Business Practice Location Address Postal Code |
660678200 |
|
Provider Business Practice Location Address Country Code If outside U S |
US |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
Provider Business Practice Location Address Telephone Number |
7852480822 |
The telephone number associated with the location address of the provider being identified. |
Provider Enumeration Date |
11/1/2022 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
11/1/2022 |
The date that a record was last updated or changed. |
Provider Gender Code |
F |
The code designating the provider’s gender if the provider is a person. |
Healthcare Provider Taxonomy Code 1 |
106S00000X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Is Sole Proprietor |
N |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
NPI Certification Date |
11/1/2022 |
|