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NPI Code Detail

MEDICARE: KENNETH VICKROY FNP

MEDICARE: KENNETH VICKROY FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208100000XPhysical Medicine & Rehabilitation PhysicianAP8000AZ

General Provider Information

NPI Number : 1285019695
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH VICKROY FNP
Provider Business Mailing Address
First Line : 222 W THOMAS RD STE 114
Second Line :
City : PHOENIX
State : AZ
Zip : 85013-4420
Country : US
Telephone Number : 602-406-4578
Fax Number : 602-424-5445
Provider Business Practice Location Address
First Line : 222 W THOMAS RD STE 114
Second Line :
City : PHOENIX
State : AZ
Zip : 85013-4420
Country : US
Telephone Number : 602-406-4578
Fax Number : 602-424-5445
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2015
Last Update Date : 06/01/2021

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Directions to “ KENNETH VICKROY FNP” Practice Location

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