Provider Demographics
NPI:1073071668
Name:MELANCON HALLEY, JENNIFER CATHERINE (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CATHERINE
Last Name:MELANCON HALLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:CATHERINE
Other - Last Name:MELANCON-HALLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-765-5727
Mailing Address - Fax:225-765-4278
Practice Address - Street 1:5000 HENNESSY BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4375
Practice Address - Country:US
Practice Address - Phone:225-765-4050
Practice Address - Fax:225-765-4046
Is Sole Proprietor?:No
Enumeration Date:2019-03-04
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA203550363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner