Provider Demographics
NPI:1154087997
Name:JUMPER, VICKIE LYNN (NP)
Entity Type:Individual
Prefix:MRS
First Name:VICKIE
Middle Name:LYNN
Last Name:JUMPER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1400 BUFORD HWY STE K4
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-8776
Mailing Address - Country:US
Mailing Address - Phone:470-354-3231
Mailing Address - Fax:470-354-3131
Practice Address - Street 1:1400 BUFORD HWY STE K4
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-8776
Practice Address - Country:US
Practice Address - Phone:470-354-3231
Practice Address - Fax:470-354-3131
Is Sole Proprietor?:No
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN190291363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health