Individual
JENNIFER ELIZABETH VICKNAIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
778 SCOGIN DR, MONTICELLO, AR 71655-5729
(870) 367-2411
Mailing address
443 FIDDLERS CREEK DR, WEST MONROE, LA 71291-1774
(318) 381-2130
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN087113
LA
367500000X
Certified Registered Nurse Anesthetist
Primary
AP04334
LA
367500000X
Certified Registered Nurse Anesthetist
C003168
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1179272
—
LA
Enumeration date
07/12/2006
Last updated
01/06/2024
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