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General NPI Number Information
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NPI Number | 1659427417
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Entity Type | Individual
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Provider Name | VICKI TESSITORE MATHERNE CNM
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Gender | Female
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 15813 PAUL VEGA MD DR STE 200
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City | HAMMOND
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State | LA
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Zip | 70403-1431
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Country | US
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Telephone | 985-230-7650
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Fax | 985-230-7655
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Provider Business Mailing Address
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Address Line | 15192 HIGHWAY 22
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City | PONCHATOULA
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State | LA
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Zip | 70454-6475
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Country | US
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Telephone | 985-370-7953
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | AP03301
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | RN064193
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License Number State | LA
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