Provider Demographics
NPI:1184147787
Name:WELCH, MELANIE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:WELCH
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4855 HIGHWAY 10 STE C
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:LA
Mailing Address - Zip Code:70638-4800
Mailing Address - Country:US
Mailing Address - Phone:800-462-0742
Mailing Address - Fax:318-634-5602
Practice Address - Street 1:4855 HIGHWAY 10 STE C
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:LA
Practice Address - Zip Code:70638-4800
Practice Address - Country:US
Practice Address - Phone:800-462-0742
Practice Address - Fax:318-634-5602
Is Sole Proprietor?:No
Enumeration Date:2017-07-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09452363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily