Provider Demographics
NPI:1528266657
Name:ELLIS-HUGHES, VICKY (CRNA)
Entity type:Individual
Prefix:MRS
First Name:VICKY
Middle Name:
Last Name:ELLIS-HUGHES
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 LAKE MICHIGAN DR
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-5136
Mailing Address - Country:US
Mailing Address - Phone:504-367-3189
Mailing Address - Fax:
Practice Address - Street 1:1415 TULANE AVE
Practice Address - Street 2:HC 71
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2600
Practice Address - Country:US
Practice Address - Phone:504-988-6649
Practice Address - Fax:504-988-6288
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN050808163W00000X
VA0024189668367500000X
TX1085391367500000X
MO2022021637367500000X
LAAP02653367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009910569Medicaid
LA1011819Medicaid