Healthcare Provider Details

I. General information

NPI: 1740544287
Provider Name (Legal Business Name): JEANIE VICKNAIR RICARD FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JEANIE VICKNAIR DELAUNE

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 10/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 VETERANS MEMORIAL BLVD
METAIRIE LA
70002-6322
US

IV. Provider business mailing address

1805 MASON SMITH AVE
METAIRIE LA
70003-5017
US

V. Phone/Fax

Practice location:
  • Phone: 504-838-3524
  • Fax: 504-828-6155
Mailing address:
  • Phone: 504-655-3145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP06894
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP06894
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN106424
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: