Jelisa Vick, AG-ACNP

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

CNP-02725 Issued in NM

Practice address

2211 Lomas Blvd NE
Trauma/Surgical Intensive Care Unit
Albuquerque, NM 87106

Phone

(505) 272-2721

NPI assigned

Jul 24, 2015

Last updated

Aug 22, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northern Arizona Healthcare CorporationGroup PAC ID 3577473362, 391 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Flagstaff Medical Center Hospital, Flagstaff, AZ, CCN 030023

Merit-based Incentive Payment System (MIPS)

Final score

82.13 of 100Reported as group

Quality

66.85

Promoting interoperability

99

Improvement activities

40

Cost

74.4

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Northern Arizona Healthcare Corporation

  • Family Medicine Physician
  • Flagstaff, AZ
  • NPI 1669914552
  Medicare reassignment Care Compare group NPD
• Flagstaff Pathology Associates

  dba Pathology Associates of Northern AZ

  • Anatomic Pathology & Clinical Pathology Physician
  • Flagstaff, AZ
  • NPI 1306205612
  NPD
• Northern Arizona Healthcare Corporation

  dba Northern Arizona Healthcare Children's Health Center

  • Multi-Specialty Clinic/Center
  • Flagstaff, AZ
  • NPI 1235732702
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Flagstaff Medical Center

  dba Guardian Air

  • Air Ambulance
  • Flagstaff, AZ
  • NPI 1427234111

  Hospital

  Care Compare affiliation
• Flagstaff Medical Center

  dba Guardian Medical Transport

  • Land Ambulance
  • Flagstaff, AZ
  • NPI 1518143205

  Hospital

  Care Compare affiliation
• Flagstaff Medical Center

  dba FMC Behavioral Health Services

  • Psychiatric Hospital Unit
  • Flagstaff, AZ
  • NPI 1649370875
  Care Compare affiliation
• Flagstaff Medical Center

  • General Acute Care Hospital
  • Flagstaff, AZ
  • NPI 1780635078
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1437696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692662400000",
    "number": "1548645021",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 967",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860020967",
            "telephone_number": "928-773-0003",
            "fax_number": "928-773-1170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2211 LOMAS BLVD NE",
            "address_2": "TRAUMA/SURGICAL INTENSIVE CARE UNIT",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "87106",
            "telephone_number": "505-272-2721"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1200 N Beaver St",
            "address_purpose": "LOCATION",
            "city": "Flagstaff",
            "state": "AZ",
            "postal_code": "860013118",
            "country_code": "US",
            "telephone_number": "928-773-0003",
            "fax_number": "928-773-1170",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VICK",
        "first_name": "JELISA",
        "credential": "AG-ACNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-24",
        "last_updated": "2023-08-22",
        "certification_date": "2023-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "AZ",
            "license": "AP8668",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "NM",
            "license": "CNP-02725",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "226889",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vibrant Pathways ABA NM LLC
• Vibrant Tranquility LLC
• Kevin Vicenti, MD
• Kyetiil Shantelle Vicenti
• Una Mary Vicenti, OT
• Roxanna Love Vick, RPH
• Christie Vickers, PHARM.D.
• Jennifer Vickers, MD
• Stephen Scott Vickers
• Wiyanna Victor Chavez, LCSW

• Acute Care Nurse Practitioner in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Acute Care Nurse Practitioner in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.