Healthcare Provider Details

I. General information

NPI: 1194396671
Provider Name (Legal Business Name): BRITTANI VICKERS MSN, PNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2021
Last Update Date: 07/12/2021
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4424 COSTELLO WAY
HAYMARKET VA
20169-2996
US

IV. Provider business mailing address

11310 BRINKER CT
CULPEPER VA
22701-5102
US

V. Phone/Fax

Practice location:
  • Phone: 703-753-1895
  • Fax:
Mailing address:
  • Phone: 540-423-7808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0024180960
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163WN0003X
TaxonomyLow-Risk Neonatal Registered Nurse
License Number104410158
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number202119582
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: