Provider Demographics
NPI:1760466072
Name:STRICKLAND, MELINDA KOONCE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:KOONCE
Last Name:STRICKLAND
Suffix:
Gender:F
Credentials:APRN
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 122205 DEPT 2205
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75312-2205
Mailing Address - Country:US
Mailing Address - Phone:337-494-2921
Mailing Address - Fax:337-494-6523
Practice Address - Street 1:1717 OAK PARK BLVD FL 1
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8977
Practice Address - Country:US
Practice Address - Phone:337-494-6800
Practice Address - Fax:337-494-6761
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA03771363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1181927Medicaid
LAAP03771OtherSTATE LICENSE
LA1181927Medicaid
P32417Medicare UPIN