1982622965 NPI number — MRS. VICKIE GAYLIN HOLLAND ARNP

Table of content: MRS. VICKIE GAYLIN HOLLAND ARNP (NPI 1982622965)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982622965 NPI number — MRS. VICKIE GAYLIN HOLLAND ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLLAND
Provider First Name:
VICKIE
Provider Middle Name:
GAYLIN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PRATER
Provider Other First Name:
VICKIE
Provider Other Middle Name:
GAYLIN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
ARNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1982622965
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1514 E. JOSEPH LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT GIBSON
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74434-8314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-478-3045
Provider Business Mailing Address Fax Number:
918-478-3045

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1011 HONOR HEIGHTS DR.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MUSKOGEE
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74401-1318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-683-3261
Provider Business Practice Location Address Fax Number:
918-680-3664
Provider Enumeration Date:
07/17/2006

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:  R0032046 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: ROO32046 . This is a "LICENSE NUMBER" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".