Provider Demographics
NPI:1497000657
Name:BREAUX, MELISSA MARTIN (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:MARTIN
Last Name:BREAUX
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MRS
Other - First Name:MELISSA
Other - Middle Name:JANE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1233 WAYNE GILMORE CIRCLE
Mailing Address - Street 2:STE 250-B
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-6405
Mailing Address - Country:US
Mailing Address - Phone:337-407-1955
Mailing Address - Fax:337-407-1956
Practice Address - Street 1:1233 WAYNE GILMORE CIRCLE
Practice Address - Street 2:SUITE 250-B
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6405
Practice Address - Country:US
Practice Address - Phone:337-407-1955
Practice Address - Fax:337-407-1956
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN063199/AP06875363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner