Healthcare Provider Details

I. General information

NPI: 1972573020
Provider Name (Legal Business Name): CARIE DARLENE RIVES-VICKERY M.C.D. , CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 08/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 ATTAKAPAS DR SUITE 201
OPELOUSAS LA
70570-6549
US

IV. Provider business mailing address

211 LIBERTY AVE #522
LAFAYETTE LA
70508-6850
US

V. Phone/Fax

Practice location:
  • Phone: 337-942-1645
  • Fax: 337-942-1659
Mailing address:
  • Phone: 337-981-9422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number5372
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: