Provider Demographics
NPI:1104176130
Name:LACOUR, MELANIE A (FNP)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:A
Last Name:LACOUR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 HOSPITAL BLVD
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-6903
Mailing Address - Country:US
Mailing Address - Phone:318-473-1426
Mailing Address - Fax:318-473-1435
Practice Address - Street 1:352 HOSPITAL BLVD
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-6903
Practice Address - Country:US
Practice Address - Phone:318-473-1426
Practice Address - Fax:318-473-1435
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07011363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2314319Medicaid