Provider Demographics
NPI:1598413049
Name:MELANCON, KAY (AGACNP)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:
Last Name:MELANCON
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:KAY
Other - Middle Name:MELANCON
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGACNP
Mailing Address - Street 1:1233 WAYNE GILMORE CIR STE 450
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-6405
Mailing Address - Country:US
Mailing Address - Phone:337-942-3006
Mailing Address - Fax:337-942-7744
Practice Address - Street 1:1233 WAYNE GILMORE CIR STE 450
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6405
Practice Address - Country:US
Practice Address - Phone:337-942-3006
Practice Address - Fax:337-942-7744
Is Sole Proprietor?:No
Enumeration Date:2022-03-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA224418363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology