Provider Demographics
NPI:1083644868
Name:SIMON, VICKIE ANN (RN AND LAC)
Entity Type:Individual
Prefix:MRS
First Name:VICKIE
Middle Name:ANN
Last Name:SIMON
Suffix:
Gender:F
Credentials:RN AND LAC
Other - Prefix:MRS
Other - First Name:VICKIE
Other - Middle Name:ANN
Other - Last Name:CAMPBELL AND FUSELIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN AND LAC
Mailing Address - Street 1:111 GAUTHIER RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-8347
Mailing Address - Country:US
Mailing Address - Phone:337-278-5396
Mailing Address - Fax:
Practice Address - Street 1:611 W ADMIRAL DOYLE DR
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-6408
Practice Address - Country:US
Practice Address - Phone:337-373-0002
Practice Address - Fax:337-373-0129
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA793101YA0400X
LARN056527163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)