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General NPI Number Information
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NPI Number | 1700876919
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Entity Type | Individual
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Provider Name | VICKIE CLINE OPA-C, LSA, SA-C
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Gender | Female
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Dates
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Enumeration Date | 10/27/2005
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Last Update Date | 06/21/2017
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Provider Practice Location Address
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Address Line | 2317 COBBLECREEK DR
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City | CONROE
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State | TX
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Zip | 77384-3703
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Country | US
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Telephone | 281-541-8872
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Fax | 331-625-7932
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Provider Business Mailing Address
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Address Line | 2317 COBBLECREEK DR
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City | CONROE
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State | TX
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Zip | 77384-3703
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Country | US
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Telephone | 281-541-8872
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Fax | 331-625-7932
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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 | 246ZS0410X
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Taxonomy Name | Surgical Technologist
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License Number | LSA: SA00167
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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