Active NPI
Melanie Renee Hanisch, DO
- Pediatrics Physician
- Owasso, OK
National Provider Identifier
1073263653
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 8214
- Practice address
- 12150 E 96TH St N Ste 101
Owasso, OK 74055-5339 - Phone
- (918) 716-5437
- NPI assigned
- Mar 25, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 8214 | OK | Primary |
Addresses
Primary practice location
12150 E 96TH St N Ste 101
Owasso, OK 74055-5339
Mailing address
4030 E 43Rd St
Tulsa, OK 74135-2745
Phone (732) 551-4026
Other practice location 1
5795 S Elm Pl
Broken Arrow, OK 74011-4893
Phone (918) 716-5437
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8214 | OK | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1648166400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1073263653",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4030 E 43RD ST",
"city": "TULSA",
"state": "OK",
"postal_code": "741352745",
"telephone_number": "732-551-4026"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12150 E 96TH ST N STE 101",
"city": "OWASSO",
"state": "OK",
"postal_code": "740555339",
"telephone_number": "918-716-5437"
}
],
"practiceLocations": [
{
"address_1": "5795 S Elm Pl",
"address_purpose": "LOCATION",
"city": "Broken Arrow",
"state": "OK",
"postal_code": "740114893",
"country_code": "US",
"telephone_number": "918-716-5437",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "HANISCH",
"first_name": "MELANIE",
"middle_name": "RENEE",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-03-25",
"last_updated": "2025-09-11",
"certification_date": "2025-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "OK",
"license": "8214",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Owasso, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.