Healthcare Provider Details

I. General information

NPI: 1497686489
Provider Name (Legal Business Name): MRS. GRACE KEHOE VICKERY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7063 VETERANS PKWY
PELL CITY AL
35125-5114
US

IV. Provider business mailing address

847 CALVERT CIR
BIRMINGHAM AL
35242-2546
US

V. Phone/Fax

Practice location:
  • Phone: 205-381-5120
  • Fax:
Mailing address:
  • Phone: 205-381-5120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-188152
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: