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General NPI Number Information
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NPI Number | 1386113306
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Entity Type | Individual
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Provider Name | CAROLINE VICKERS PHYSICIAN ASSISTANT
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Gender | Female
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Dates
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Enumeration Date | 11/20/2018
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Last Update Date | 07/24/2019
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Provider Practice Location Address
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Address Line | RADAR US ARMY HEALTH CLINIC 401 CARPENTER ROAD
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City | FORT MYER
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State | VA
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Zip | 22211
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Country | US
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Telephone | 703-696-3032
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Fax |
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Provider Business Mailing Address
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Address Line | 1203 COLLINGWOOD RD
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City | ALEXANDRIA
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State | VA
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Zip | 22308-1729
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Country | US
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Telephone | 609-203-2385
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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