Healthcare Provider Details

I. General information

NPI: 1821384587
Provider Name (Legal Business Name): VICKIE KEFFER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 12/30/2021
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1609 WEST 40TH AVENUE SUITE 205
PINE BLUFF AR
71603
US

IV. Provider business mailing address

PO BOX 2650
PINE BLUFF AR
71613-2650
US

V. Phone/Fax

Practice location:
  • Phone: 870-541-3230
  • Fax:
Mailing address:
  • Phone: 870-541-7211
  • Fax: 479-841-4297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR36154
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA03524 ANP
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: