Provider Demographics
NPI:1689978975
Name:JEWELL, KAYLII MELANCON (RN, BSN, CNOR, RNFA)
Entity Type:Individual
Prefix:MRS
First Name:KAYLII
Middle Name:MELANCON
Last Name:JEWELL
Suffix:
Gender:F
Credentials:RN, BSN, CNOR, RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14321 VENTRESS RD
Mailing Address - Street 2:
Mailing Address - City:VENTRESS
Mailing Address - State:LA
Mailing Address - Zip Code:70783-4005
Mailing Address - Country:US
Mailing Address - Phone:225-978-3754
Mailing Address - Fax:
Practice Address - Street 1:5233 DIJON DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4692
Practice Address - Country:US
Practice Address - Phone:225-766-2166
Practice Address - Fax:225-766-2164
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-01
Last Update Date:2011-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN103777163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant