Healthcare Provider Details

I. General information

NPI: 1346211737
Provider Name (Legal Business Name): JOSEPH PATRICK MCVICKER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL HOSPITAL, ANESTHESIA DEPARTMENT 100 BREWSTER BLVD
CAMP LEJEUNE NC
28547
US

IV. Provider business mailing address

139 YACHT CLUB DR
NEWPORT NC
28570-9085
US

V. Phone/Fax

Practice location:
  • Phone: 910-450-3326
  • Fax:
Mailing address:
  • Phone: 252-393-1109
  • Fax: 252-393-1109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number168656
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberC01382
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number168656
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024165747
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: