Provider Demographics
NPI:1902040033
Name:BROWN, MELISSA M (ANP-C)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:M
Last Name:BROWN
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5326 SHARP ROAD
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471
Mailing Address - Country:US
Mailing Address - Phone:985-674-1481
Mailing Address - Fax:985-626-6956
Practice Address - Street 1:3295 EAST CAUSEWAY APPROACH
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448
Practice Address - Country:US
Practice Address - Phone:985-674-4015
Practice Address - Fax:985-626-6956
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN051806-AP05770363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1812226Medicaid
LA1154652618Medicare PIN