Provider Demographics
NPI:1366268856
Name:MELANCON, CRYSTAL (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:MELANCON
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 JEANUS RD
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-8276
Mailing Address - Country:US
Mailing Address - Phone:337-459-5305
Mailing Address - Fax:
Practice Address - Street 1:537 E MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586-4611
Practice Address - Country:US
Practice Address - Phone:337-459-5305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-29
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA201809163WL0100X
L-309651174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant