MEDICARE: MELISSA SUE WARD PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	235428	LA
2	163W00000X	Registered Nurse	RN140948	LA

General Provider Information

NPI Number	:	1093468522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA SUE WARD PMHNP-BC

Provider Business Mailing Address
First Line	:	PO BOX 792
Second Line	:
City	:	BASTROP
State	:	LA
Zip	:	71221-0792
Country	:	US
Telephone Number	:	318-283-8887
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 DURHAM ST
Second Line	:
City	:	BASTROP
State	:	LA
Zip	:	71220-5012
Country	:	US
Telephone Number	:	318-556-8440
Fax Number	:	318-556-8449

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2022
Last Update Date	:	03/20/2025

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