Provider Demographics
NPI:1649996299
Name:MEDLIN, NICOLE (NNP)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:MEDLIN
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6445 SWEETLEAF CT
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-0294
Mailing Address - Country:US
Mailing Address - Phone:337-802-0132
Mailing Address - Fax:337-480-7051
Practice Address - Street 1:1900 W GAUTHIER RD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-7170
Practice Address - Country:US
Practice Address - Phone:337-480-7050
Practice Address - Fax:337-480-7051
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN096891163WN0002X
LAAP04599363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care