Healthcare Provider Details

I. General information

NPI: 1306246194
Provider Name (Legal Business Name): VICKI LYNNE KENT ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2014
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 W ORCHARD AVE STE A
HERMISTON OR
97838-1592
US

IV. Provider business mailing address

955 W ORCHARD AVE STE A
HERMISTON OR
97838-1592
US

V. Phone/Fax

Practice location:
  • Phone: 541-289-1637
  • Fax: 541-567-2552
Mailing address:
  • Phone: 541-289-1637
  • Fax: 541-567-2552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201405812NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: