Healthcare Provider Details

I. General information

NPI: 1952407728
Provider Name (Legal Business Name): MELISSA GUILBEAU FNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 07/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 RUE FOUNTAINE SUITE 108
LAFAYETTE LA
70508-5742
US

IV. Provider business mailing address

PO BOX 81515
LAFAYETTE LA
70598-1515
US

V. Phone/Fax

Practice location:
  • Phone: 337-889-3682
  • Fax: 337-534-0798
Mailing address:
  • Phone: 337-889-3682
  • Fax: 337-534-0798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberRN100054
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP04767
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP04767
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: