Provider Demographics
NPI:1043560550
Name:VICKERS, KIPP (BA)
Entity Type:Individual
Prefix:
First Name:KIPP
Middle Name:
Last Name:VICKERS
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 S MIAMI AVE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130
Mailing Address - Country:US
Mailing Address - Phone:305-779-9600
Mailing Address - Fax:
Practice Address - Street 1:155 S MIAMI AVE
Practice Address - Street 2:#700
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130
Practice Address - Country:US
Practice Address - Phone:305-779-9600
Practice Address - Fax:305-779-9600
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator