Provider Demographics
NPI:1235485640
Name:WILKS, MELINDA (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:
Last Name:WILKS
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5611 PRATT DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-2644
Mailing Address - Country:US
Mailing Address - Phone:504-616-3104
Mailing Address - Fax:
Practice Address - Street 1:5611 PRATT DR
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122-2644
Practice Address - Country:US
Practice Address - Phone:504-616-3104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-03
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200931163W00000X
LA1146106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist