Provider Demographics
NPI:1851539258
Name:VICKNAIR, ROHINI S (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ROHINI
Middle Name:S
Last Name:VICKNAIR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ROHINI
Other - Middle Name:S
Other - Last Name:BERNHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:806 JEFFERSON TER
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-5727
Mailing Address - Country:US
Mailing Address - Phone:337-365-4945
Mailing Address - Fax:337-367-3917
Practice Address - Street 1:1004 SURREY ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501
Practice Address - Country:US
Practice Address - Phone:337-456-6768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-23
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002929363A00000X
LA200209363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2132881Medicaid