Provider Demographics
NPI:1821762782
Name:VICK, ALICIA MCMILLIN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:MCMILLIN
Last Name:VICK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 HENNESSY BLVD STE 2004
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4370
Mailing Address - Country:US
Mailing Address - Phone:252-769-2500
Mailing Address - Fax:225-769-9424
Practice Address - Street 1:7777 HENNESSY BLVD STE 2004
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4370
Practice Address - Country:US
Practice Address - Phone:252-769-2500
Practice Address - Fax:225-769-9424
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3288292363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical