Healthcare Provider Details

I. General information

NPI: 1235485640
Provider Name (Legal Business Name): MELINDA WILKS APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2012
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5611 PRATT DR
NEW ORLEANS LA
70122-2644
US

IV. Provider business mailing address

5611 PRATT DR
NEW ORLEANS LA
70122-2644
US

V. Phone/Fax

Practice location:
  • Phone: 504-616-3104
  • Fax:
Mailing address:
  • Phone: 504-616-3104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number200931
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number200931
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: