Basic Information
| Provider Information | |||||||||
| NPI: | 1821762782 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VICK | ||||||||
| FirstName: | ALICIA | ||||||||
| MiddleName: | MCMILLIN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7777 HENNESSY BLVD STE 2004 | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708084370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2527692500 | ||||||||
| FaxNumber: | 2257699424 | ||||||||
| Practice Location | |||||||||
| Address1: | 7777 HENNESSY BLVD STE 2004 | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708084370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2527692500 | ||||||||
| FaxNumber: | 2257699424 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2021 | ||||||||
| LastUpdateDate: | 08/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 3288292 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.