1598039539 NPI number — MRS. KAREN WATSON VICKERS MSN, RN, FNP-C

Table of content: MRS. KAREN WATSON VICKERS MSN, RN, FNP-C (NPI 1598039539)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598039539 NPI number — MRS. KAREN WATSON VICKERS MSN, RN, FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VICKERS
Provider First Name:
KAREN
Provider Middle Name:
WATSON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSN, RN, FNP-C
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:
1598039539
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10208 CERNY ST STE 210
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27617-7885
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-457-0340
Provider Business Mailing Address Fax Number:
919-806-8878

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2530 MERIDIAN PKWY STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27713-5273
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
984-257-7565
Provider Business Practice Location Address Fax Number:
984-257-0190
Provider Enumeration Date:
03/07/2012

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: 363LF0000X , with the licence number:  0024185207 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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