Provider Demographics
NPI:1295191930
Name:MELANCON, JAIMIE VINCENT (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:JAIMIE
Middle Name:VINCENT
Last Name:MELANCON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 IBERIA ST STE 3A
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70592-6370
Mailing Address - Country:US
Mailing Address - Phone:337-450-3047
Mailing Address - Fax:337-450-3050
Practice Address - Street 1:327 IBERIA ST STE 3A
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:LA
Practice Address - Zip Code:70592-6370
Practice Address - Country:US
Practice Address - Phone:337-450-3047
Practice Address - Fax:337-450-3050
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-11
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95063008163W00000X
LARN127314163WE0003X
LAAP08605363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WE0003XNursing Service ProvidersRegistered NurseEmergency