Provider Demographics
NPI:1427285055
Name:WOOTEN, MELISSA R (NNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:R
Last Name:WOOTEN
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35805
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71294-5805
Mailing Address - Country:US
Mailing Address - Phone:318-329-4232
Mailing Address - Fax:318-329-4234
Practice Address - Street 1:503 MCMILLAN RD
Practice Address - Street 2:ATTN: NICU
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-5327
Practice Address - Country:US
Practice Address - Phone:318-329-4200
Practice Address - Fax:318-329-4710
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN089563363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care