Healthcare Provider Details

I. General information

NPI: 1376630384
Provider Name (Legal Business Name): VICKIE L. THOMAS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 PURYEAR ST
ROXBORO NC
27573-4241
US

IV. Provider business mailing address

138 PURYEAR ST
ROXBORO NC
27573-4241
US

V. Phone/Fax

Practice location:
  • Phone: 606-615-5210
  • Fax: 252-514-2881
Mailing address:
  • Phone: 606-615-5210
  • Fax: 252-514-2881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5205P
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5016304
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number67306
License Number StateWV
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11029721
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3005205
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: