Healthcare Provider Details

I. General information

NPI: 1629124441
Provider Name (Legal Business Name): VICKIE VERMILLION
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15909 S LINDENWOOD DR
OLATHE KS
66062-4021
US

IV. Provider business mailing address

15909 S LINDENWOOD DR
OLATHE KS
66062-4021
US

V. Phone/Fax

Practice location:
  • Phone: 913-397-6171
  • Fax:
Mailing address:
  • Phone: 913-397-6171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: