Healthcare Provider Details

I. General information

NPI: 1861209710
Provider Name (Legal Business Name): VICKI E MOSTELLER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VICKI ROBERTS SHAW

II. Dates (important events)

Enumeration Date: 12/13/2024
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 OLD FIDDLE RD
WAYNESVILLE NC
28786-7882
US

IV. Provider business mailing address

6 ROBERTS RD
ASHEVILLE NC
28803-8699
US

V. Phone/Fax

Practice location:
  • Phone: 478-319-0258
  • Fax:
Mailing address:
  • Phone: 855-694-8288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number91947
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: