Provider Demographics
NPI:1033139373
Name:VITAL, CHARISSE L (APRN)
Entity Type:Individual
Prefix:MRS
First Name:CHARISSE
Middle Name:L
Last Name:VITAL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CHARISSE
Other - Middle Name:V
Other - Last Name:BARNES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:3715 PRYTANIA ST
Mailing Address - Street 2:STE. 400
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-3761
Mailing Address - Country:US
Mailing Address - Phone:504-897-8255
Mailing Address - Fax:504-897-8336
Practice Address - Street 1:3715 PRYTANIA ST
Practice Address - Street 2:STE. 400
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-3761
Practice Address - Country:US
Practice Address - Phone:504-897-8255
Practice Address - Fax:504-897-8336
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP03273363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1552861Medicaid
LA1552861Medicaid
LAS98585Medicare UPIN