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General NPI Number Information
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NPI Number | 1255194494
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Entity Type | Individual
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Provider Name | STEPHANIE LYNN VICK FNP-C
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Gender | Female
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Dates
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Enumeration Date | 01/31/2024
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Last Update Date | 12/21/2025
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Provider Practice Location Address
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Address Line | 1718 OLD REYNOLDS ST
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City | WAYCROSS
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State | GA
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Zip | 31501-1036
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Country | US
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Telephone | 912-283-5260
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Fax |
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Provider Business Mailing Address
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Address Line | 1307 DAN DURAN RD
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City | NICHOLLS
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State | GA
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Zip | 31554-5837
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Country | US
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Telephone | 912-327-0182
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN209399
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License Number State | GA
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