Healthcare Provider Details

I. General information

NPI: 1497127641
Provider Name (Legal Business Name): CAROLINE HAWTHORNE VICKERS MSN, APRN, AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2015
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 E HARVARD AVE STE 405
DENVER CO
80210
US

IV. Provider business mailing address

1805 SHEA CENTER DR STE 450
HIGHLANDS RANCH CO
80129-2255
US

V. Phone/Fax

Practice location:
  • Phone: 303-584-8900
  • Fax: 303-584-0525
Mailing address:
  • Phone: 303-357-2559
  • Fax: 303-584-8900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP129469
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: