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General NPI Number Information
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NPI Number | 1386668648
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Entity Type | Individual
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Provider Name | VICKIE GLOVER PA
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Gender | Female
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 01/11/2024
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Provider Practice Location Address
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Address Line | 13649 CHURCH STREET
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City | WILLISTON
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State | SC
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Zip | 29853
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Country | US
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Telephone | 803-266-0060
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Fax | 803-266-0042
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Provider Business Mailing Address
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Address Line | 86 WREN STREET
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City | BARNWELL
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State | SC
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Zip | 29812
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Country | US
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Telephone | 803-259-5762
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Fax | 803-259-3050
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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 | 00047961
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License Number State | SC
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