Provider Demographics
NPI:1104830355
Name:OWENS, VICKY LYNN (NP)
Entity Type:Individual
Prefix:
First Name:VICKY
Middle Name:LYNN
Last Name:OWENS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPT. 453 PO BOX 1000
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:828-575-2625
Mailing Address - Fax:282-350-2174
Practice Address - Street 1:11501 CUMBERLAND RD STE 500
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-7010
Practice Address - Country:US
Practice Address - Phone:317-863-9300
Practice Address - Fax:317-863-9333
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001338A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ININ1125029OtherMEDICARE
IN200439040Medicaid
ININ1126019OtherMEDICARE