Healthcare Provider Details

I. General information

NPI: 1932018157
Provider Name (Legal Business Name): SANDRA CARR VICK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 FAIRVIEW DR
FRANKLIN VA
23851-1214
US

IV. Provider business mailing address

22458 CAPTAIN JOHN RD
COURTLAND VA
23837-1211
US

V. Phone/Fax

Practice location:
  • Phone: 757-569-6272
  • Fax:
Mailing address:
  • Phone: 757-653-8149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number0001110839
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: