MEDICARE: DR. VICKIE N HARRELL M.D.

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
1	208D00000X	General Practice Physician	ME0070385	FL
2	207R00000X	Internal Medicine Physician	ME0070385	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730155060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VICKIE N HARRELL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1330
Second Line	:
City	:	LYNN HAVEN
State	:	FL
Zip	:	32444
Country	:	US
Telephone Number	:	850-913-0018
Fax Number	:	850-913-9137

Provider Business Practice Location Address
First Line	:	292 FOREST PARK CIR
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4921
Country	:	US
Telephone Number	:	850-913-0018
Fax Number	:	850-913-9137

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	10/23/2019

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