Individual
RICKY RAY MELANCON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1978 INDUSTRIAL BLVD, HOUMA, LA 70363-7055
(985) 873-2200
Mailing address
409 ABBY RD, THIBODAUX, LA 70301-6022
(985) 446-8606
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN038573 AP03634
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1485811
—
LA
Enumeration date
11/15/2006
Last updated
07/08/2007
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