MEDICARE: LANCE ADKINS VICKERY APRN

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	363LF0000X	Family Nurse Practitioner	141455	KS
2	363L00000X	Nurse Practitioner	2011034116	MO

General Provider Information

NPI Number	:	1801101613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANCE ADKINS VICKERY APRN

Provider Business Mailing Address
First Line	:	600 NW PRYOR RD
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64081-1104
Country	:	US
Telephone Number	:	816-500-0487
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 NW PRYOR RD
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64081-1104
Country	:	US
Telephone Number	:	816-500-0487
Fax Number	:

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

Provider Enumeration Date	:	08/17/2010
Last Update Date	:	12/23/2011

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Directions to “ LANCE ADKINS VICKERY APRN” Practice Location

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