Healthcare Provider Details

I. General information

NPI: 1184549412
Provider Name (Legal Business Name): GLADYS MELANCON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 RICHARD ST
BREAUX BRIDGE LA
70517-6039
US

IV. Provider business mailing address

402 RICHARD ST
BREAUX BRIDGE LA
70517-6039
US

V. Phone/Fax

Practice location:
  • Phone: 337-332-1810
  • Fax: 337-332-3300
Mailing address:
  • Phone: 337-332-1810
  • Fax: 337-332-3300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: