Healthcare Provider Details

I. General information

NPI: 1639268170
Provider Name (Legal Business Name): VICKREY VAUGHN KINKADE APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 09/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 BROWNING WAY SUITE 104
ELKO NV
89801-8348
US

IV. Provider business mailing address

1775 BROWNING WAY SUITE 104
ELKO NV
89801-8348
US

V. Phone/Fax

Practice location:
  • Phone: 775-778-0386
  • Fax: 775-777-1152
Mailing address:
  • Phone: 775-778-0386
  • Fax: 775-777-1152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAPN00364
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberRN19842
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: