Provider Demographics
NPI:1720213481
Name:THOMAS, MELANIE YVETTE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:YVETTE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9118 BLUEBONNET CENTRE BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809
Mailing Address - Country:US
Mailing Address - Phone:225-368-2300
Mailing Address - Fax:225-368-2280
Practice Address - Street 1:9118 BLUEBONNET CENTRE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809
Practice Address - Country:US
Practice Address - Phone:225-368-2300
Practice Address - Fax:225-368-2280
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05603363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1800465Medicaid
LA3B280CS42Medicare PIN