Provider Demographics
NPI:1144388034
Name:VICK, HAROLD LOUIS JR (NP)
Entity Type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:LOUIS
Last Name:VICK
Suffix:JR
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11810 STATE HIGHWAY 195
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-4831
Mailing Address - Country:US
Mailing Address - Phone:210-279-1018
Mailing Address - Fax:
Practice Address - Street 1:11810 STATE HIGHWAY 195
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-4831
Practice Address - Country:US
Practice Address - Phone:210-279-1018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.12362363LF0000X
TX110847363LF0000X
MTNUR-APRN-LIC-128099363LF0000X
TXAP110847363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP110847OtherNURSE PRACTITIONER
TXAP110847OtherNURSE PRACTITIONER
TX676114OtherFAMILY NURSE PRACTITIONER