Melanie G. Petchak, NP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

APO3820 Issued in LA

Practice address

7611 Saint Vincent Ave
Shreveport, LA 71106-4231

Phone

(318) 861-1671

NPI assigned

Apr 13, 2007

Last updated

Nov 19, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Geriatric Nurse Practitioner Consultants IncGroup PAC ID 6507398294, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Geriatric Nurse Practitioner Consultants Inc

  • Family Nurse Practitioner
  • Shreveport, LA
  • NPI 1932527249
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731974400000",
    "number": "1336363845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 SAINT MARY PL",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711014343",
            "telephone_number": "318-861-1671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7611 SAINT VINCENT AVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711064231",
            "telephone_number": "318-861-1671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETCHAK",
        "first_name": "MELANIE",
        "middle_name": "G.",
        "credential": "NP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-13",
        "last_updated": "2024-11-19",
        "certification_date": "2024-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "LA",
            "license": "APO3820",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1166430",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wyonnie Perry, LCSW-BACS
• Perry's Transportation Service, LLC
• Cristen Markos Person, AU.D, CCC-A
• Personal Solutions, Inc.
• Susan Pesnell Gaines
• Alexandra Elizabeth Peters, MD
• Cynthia Peters
• Pam Peters
• Murray Evelyn Petersen, MD
• Peterson Counseling Services, LLC

• Family Nurse Practitioner in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Family Nurse Practitioner in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.