Healthcare Provider Details

I. General information

NPI: 1457577934
Provider Name (Legal Business Name): REBECCA JEAN VICKERS RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 S LANCASTER RD
DALLAS TX
75216-4531
US

IV. Provider business mailing address

1402 DOWDY FERRY RD
HUTCHINS TX
75141-4027
US

V. Phone/Fax

Practice location:
  • Phone: 214-371-0474
  • Fax: 214-371-3933
Mailing address:
  • Phone: 214-371-0474
  • Fax: 217-371-3933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number654073
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: