Provider Demographics
NPI:1407006109
Name:VICKNAIR, BEVERLY BURT (RN)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:BURT
Last Name:VICKNAIR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12045 HOMEPORT DR
Mailing Address - Street 2:
Mailing Address - City:MAUREPAS
Mailing Address - State:LA
Mailing Address - Zip Code:70449-3043
Mailing Address - Country:US
Mailing Address - Phone:225-698-3445
Mailing Address - Fax:
Practice Address - Street 1:2550 FLORIDA BLVD SW
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-4951
Practice Address - Country:US
Practice Address - Phone:225-667-2792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN070442163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH1000XNursing Service ProvidersRegistered NurseHospice