1215912027 NPI number — MS. VICKI L WILCOXSON APRN

Table of content: MS. VICKI L WILCOXSON APRN (NPI 1215912027)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215912027 NPI number — MS. VICKI L WILCOXSON APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILCOXSON
Provider First Name:
VICKI
Provider Middle Name:
L
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215912027
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
785 5TH AVE STE 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHAMBERSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17201-4232
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-263-9555
Provider Business Mailing Address Fax Number:
717-709-6529

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 ST PAUL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHAMBERSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17201-1036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-217-6944
Provider Business Practice Location Address Fax Number:
717-303-3729
Provider Enumeration Date:
12/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  SP007353 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2100X , with the licence number: ARNP9438475 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163W00000X , with the licence number: RN536557 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2100X , with the licence number: SP007353 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 25-1716306 . This is a "DEVON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007307260034 . This is a "MEDICAID GROUP #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 867633 . This is a "MEDICARE GROUP #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: SP007353 . This is a "LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 018404700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com