Provider Demographics
NPI:1205376605
Name:ALEXANDER, VICKY
Entity Type:Individual
Prefix:MRS
First Name:VICKY
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:VICKY
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C, CDE
Mailing Address - Street 1:233 N HOUSTON RD
Mailing Address - Street 2:SUITE 140D
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-3074
Mailing Address - Country:US
Mailing Address - Phone:478-975-6758
Mailing Address - Fax:478-975-6776
Practice Address - Street 1:233 N HOUSTON RD
Practice Address - Street 2:SUITE 140D
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3074
Practice Address - Country:US
Practice Address - Phone:478-975-6758
Practice Address - Fax:478-975-6776
Is Sole Proprietor?:No
Enumeration Date:2017-03-03
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN103600363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily