Active NPI
Jennifer Melancon, PT,DPT,CKTP
- Physical Therapist
- Lafayette, LA
National Provider Identifier
1295080927
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 09043R
- Practice address
- 3149 Ambassador Caffery Pkwy
Lafayette, LA 70506-7209 - Phone
- (337) 706-3455
- NPI assigned
- Jul 18, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 09043R | LA | Primary |
Addresses
Primary practice location
3149 Ambassador Caffery Pkwy
Lafayette, LA 70506-7209
Mailing address
3149 Ambassador Caffery Pkwy
Lafayette, LA 70506-7209
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 13792080 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 09043R | LA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1342569600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1500854400000",
"number": "1295080927",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3149 AMBASSADOR CAFFERY PKWY",
"city": "LAFAYETTE",
"state": "LA",
"postal_code": "705067209"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3149 AMBASSADOR CAFFERY PKWY",
"city": "LAFAYETTE",
"state": "LA",
"postal_code": "705067209",
"telephone_number": "337-706-3455"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MELANCON",
"first_name": "JENNIFER",
"name_prefix": "Dr.",
"credential": "PT,DPT,CKTP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-07-18",
"last_updated": "2017-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "LA",
"license": "09043R",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "13792080",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lafayette, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.