Provider Demographics
NPI:1871688788
Name:VINING, ALLISON CLAIRE RICHARD (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON CLAIRE
Middle Name:RICHARD
Last Name:VINING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:ALLISON
Other - Middle Name:CLAIRE
Other - Last Name:RICHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:199 RAVENSAIDE DR
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-8356
Mailing Address - Country:US
Mailing Address - Phone:337-298-3961
Mailing Address - Fax:
Practice Address - Street 1:602 N ACADIA RD
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4847
Practice Address - Country:US
Practice Address - Phone:337-493-4843
Practice Address - Fax:337-449-4615
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA2001.02363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1458279Medicaid