Provider Demographics
NPI:1679802177
Name:DEKEMEL, MELISSA STOCKSTILL (CRNA)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:STOCKSTILL
Last Name:DEKEMEL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 GAUSE BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-2007
Mailing Address - Country:US
Mailing Address - Phone:985-641-8008
Mailing Address - Fax:985-649-4063
Practice Address - Street 1:1700 LINDBERG DR
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-8062
Practice Address - Country:US
Practice Address - Phone:985-641-8008
Practice Address - Fax:985-649-4063
Is Sole Proprietor?:No
Enumeration Date:2009-12-11
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN081955367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2142941Medicaid
LA3C434Medicare PIN