Provider Demographics
NPI:1144418310
Name:JINNY R. VICROY, ARNP PLLC
Entity Type:Organization
Organization Name:JINNY R. VICROY, ARNP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JINNY
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:VICROY
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:859-276-1946
Mailing Address - Street 1:2040 REGENCY RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2331
Mailing Address - Country:US
Mailing Address - Phone:859-276-1946
Mailing Address - Fax:
Practice Address - Street 1:2040 REGENCY RD
Practice Address - Street 2:SUITE F
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2331
Practice Address - Country:US
Practice Address - Phone:859-276-1946
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1041085363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty