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General NPI Number Information
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NPI Number | 1679587562
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Entity Type | Individual
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Provider Name | MELISSA ARON GILLUM PA
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Gender | Female
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 10/16/2025
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Provider Practice Location Address
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Address Line | 1501 KINGS HWY DEPARTMENT OF EMERGENCY MEDICINE
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City | SHREVEPORT
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State | LA
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Zip | 71103-4228
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Country | US
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Telephone | 318-675-6632
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Fax |
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Provider Business Mailing Address
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Address Line | 1549 E 70TH ST STE 300
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City | SHREVEPORT
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State | LA
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Zip | 71105-5056
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Country | US
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Telephone | 318-300-3898
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Fax | 318-797-4241
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA.A10382
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA10382RX
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License Number State | LA
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