Healthcare Provider Details

I. General information

NPI: 1598413049
Provider Name (Legal Business Name): KAY CHRISTINE MELANCON AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAY MELANCON LEE AGACNP

II. Dates (important events)

Enumeration Date: 03/14/2022
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4809 AMBASSADOR CAFFERY PKWY STE 490
LAFAYETTE LA
70508-8802
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 337-470-3980
  • Fax: 337-470-3989
Mailing address:
  • Phone: 337-470-3980
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number224418
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number224418
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: