MEDICARE: MRS. VICKIE ANN CAROTHERS CFNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	0017138388	VA

General Provider Information

NPI Number	:	1982791406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VICKIE ANN CAROTHERS CFNP

Provider Business Mailing Address
First Line	:	235 CANTRELL AVE.
Second Line	:	MSC-7901 MONTPELIER HALL
City	:	HARRISONBURG
State	:	VA
Zip	:	22801-4727
Country	:	US
Telephone Number	:	540-564-1839
Fax Number	:	540-568-6176

Provider Business Practice Location Address
First Line	:	UNIVERSITY HEALTH CENTER JAMES MADISON UNIVERSITY
Second Line	:	MSC 7901
City	:	HARRISONBURG
State	:	VA
Zip	:	22807-0001
Country	:	US
Telephone Number	:	540-568-7321
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	02/23/2012

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