MEDICARE: MRS. DAWN MELANCON APRN, FNP-C

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	363L00000X	Nurse Practitioner	AP07980	LA
2	363LX0106X	Occupational Health Nurse Practitioner	AP07980	LA
3	363LF0000X	Family Nurse Practitioner	AP07980	LA

General Provider Information

NPI Number	:	1548678469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DAWN MELANCON APRN, FNP-C

Provider Business Mailing Address
First Line	:	4021 WE HECK CT
Second Line	:	STE B1
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-0405
Country	:	US
Telephone Number	:	225-256-7945
Fax Number	:	225-450-1736

Provider Business Practice Location Address
First Line	:	14360 WAX RD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70818-4279
Country	:	US
Telephone Number	:	225-261-6541
Fax Number	:	225-262-0502

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

Provider Enumeration Date	:	07/23/2014
Last Update Date	:	05/28/2020

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