MEDICARE: MRS. JAMIE ANN MCVICKER FNP-C

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	95016338	CA

General Provider Information

NPI Number	:	1922675271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JAMIE ANN MCVICKER FNP-C

Provider Business Mailing Address
First Line	:	145 KINN AVE
Second Line	:
City	:	BEAUMONT
State	:	CA
Zip	:	92223-3002
Country	:	US
Telephone Number	:	909-831-2054
Fax Number	:

Provider Business Practice Location Address
First Line	:	520 E TEMPLE ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90012-4024
Country	:	US
Telephone Number	:	213-473-6960
Fax Number	:

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

Provider Enumeration Date	:	06/07/2021
Last Update Date	:	03/08/2022

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