Provider Demographics
NPI:1740544287
Name:RICARD, JEANIE VICKNAIR (FNP-C)
Entity type:Individual
Prefix:
First Name:JEANIE
Middle Name:VICKNAIR
Last Name:RICARD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:JEANIE
Other - Middle Name:VICKNAIR
Other - Last Name:DELAUNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1805 MASON SMITH AVE
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70003-5017
Mailing Address - Country:US
Mailing Address - Phone:504-655-3145
Mailing Address - Fax:
Practice Address - Street 1:2215 VETERANS MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-6322
Practice Address - Country:US
Practice Address - Phone:504-838-3524
Practice Address - Fax:504-828-6155
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN106424163W00000X
LAAP06894363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2302337Medicaid
LA246082YH9WMedicare PIN