Provider Demographics
NPI:1710146113
Name:MIRE, MELANIE P (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:P
Last Name:MIRE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7725
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70010-7725
Mailing Address - Country:US
Mailing Address - Phone:504-887-7207
Mailing Address - Fax:
Practice Address - Street 1:1200 PINNACLE PKWY STE 7
Practice Address - Street 2:SUITE 230
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-9169
Practice Address - Country:US
Practice Address - Phone:985-643-4144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.A10541363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAP71669Medicare UPIN
LA5CC82P446Medicare PIN
LA5C614P470Medicare PIN