Healthcare Provider Details

I. General information

NPI: 1083170765
Provider Name (Legal Business Name): MELISSA CROWE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2019
Last Update Date: 02/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W UNIVERSITY AVE
HAMMOND LA
70401-1304
US

IV. Provider business mailing address

21086 SYLVEST RD
FRANKLINTON LA
70438-3138
US

V. Phone/Fax

Practice location:
  • Phone: 985-549-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: