Individual provider Active NPI

Melissa Wood, FNP

  • Family Nurse Practitioner
  • Kansas City, MO
National Provider Identifier
1528487097
Registry record updated Dec 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
2017036846 Issued in MO
Practice address
1412 NW Vivion Rd
Kansas City, MO 64118-4555
Phone
(816) 214-5276
Fax
(855) 843-8341
NPI assigned
Apr 14, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 0991112 CO
Family Nurse Practitioner 363LF0000X 2017036846 MO Primary

Addresses

Primary practice location

1412 NW Vivion Rd
Kansas City, MO 64118-4555

Mailing address

1412 NW Vivion Rd
Kansas City, MO 64118-4555
Phone (816) 214-5276

Other identifiers 2

IdentifierTypeStateIssuer
24824372MedicaidCO
482258YRAQOtherCOMEDICARE PTAN

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)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
0991112COMDFamily Nurse Practitioner
2017036846MOMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Pikes Peak Reflux and Weight Loss Surgery PLLC CurrentSince Sep 1, 2019 Accepting new patients

Locations

4810 Rusina Rd
Ste B
Colorado Springs, CO 80907
Phone (719) 358-5377

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1397433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702425600000",
    "number": "1528487097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1412 NW VIVION RD",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641184555",
            "telephone_number": "816-214-5276",
            "fax_number": "855-843-8341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1412 NW VIVION RD",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641184555",
            "telephone_number": "816-214-5276",
            "fax_number": "855-843-8341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOOD",
        "first_name": "MELISSA",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-14",
        "last_updated": "2023-12-13",
        "certification_date": "2023-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CO",
            "license": "0991112",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2017036846",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "24824372",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "482258YRAQ",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kansas City, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.