Provider Demographics
NPI:1326176942
Name:WARD, VICKIE KAY (ANP-BC)
Entity Type:Individual
Prefix:
First Name:VICKIE
Middle Name:KAY
Last Name:WARD
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17100 E CHEYENNE DR
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64056-1519
Mailing Address - Country:US
Mailing Address - Phone:816-257-5145
Mailing Address - Fax:
Practice Address - Street 1:100 W 1ST ST
Practice Address - Street 2:
Practice Address - City:HIGGINSVILLE
Practice Address - State:MO
Practice Address - Zip Code:64037-1171
Practice Address - Country:US
Practice Address - Phone:660-584-4817
Practice Address - Fax:660-584-9288
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO051608363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO423848407Medicaid
MO423848407Medicaid
MO3438735Medicare PIN