Healthcare Provider Details

I. General information

NPI: 1154913994
Provider Name (Legal Business Name): VICKI LEE FICKES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 02/03/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 INDUSTRIAL RD
HILLSBORO KS
67063-9602
US

IV. Provider business mailing address

101 INDUSTRIAL RD
HILLSBORO KS
67063-9602
US

V. Phone/Fax

Practice location:
  • Phone: 620-947-3114
  • Fax:
Mailing address:
  • Phone: 620-947-3114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number13-140281
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number13-140281
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: