Provider Demographics
NPI:1033309687
Name:VINES, MELISSA BRANCH (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:BRANCH
Last Name:VINES
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 SOUTH CAPITOL
Mailing Address - Street 2:
Mailing Address - City:MANY
Mailing Address - State:LA
Mailing Address - Zip Code:71449-3717
Mailing Address - Country:US
Mailing Address - Phone:318-256-2000
Mailing Address - Fax:
Practice Address - Street 1:11340 TEXAS HWY
Practice Address - Street 2:
Practice Address - City:MANY
Practice Address - State:LA
Practice Address - Zip Code:71449-5611
Practice Address - Country:US
Practice Address - Phone:318-315-0574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05264363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily