Provider Demographics
NPI:1346553872
Name:FARMER VICKERS, TIFFANY (APRN)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:
Last Name:FARMER VICKERS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 VILLAGE CIR STE 3
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-5418
Mailing Address - Country:US
Mailing Address - Phone:985-774-4989
Mailing Address - Fax:985-288-5466
Practice Address - Street 1:202 VILLAGE CIR STE 3
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-5418
Practice Address - Country:US
Practice Address - Phone:985-774-4989
Practice Address - Fax:985-288-5466
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06193363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LARN097301OtherLA LICENSE
LA295230OtherLA MEDICARE
LA2121375Medicaid
LAAP06193OtherLA LICENSE