Provider Demographics
NPI:1356479836
Name:EBONE, VICKY A (MSN, APRN, GNP-C)
Entity Type:Individual
Prefix:MRS
First Name:VICKY
Middle Name:A
Last Name:EBONE
Suffix:
Gender:F
Credentials:MSN, APRN, GNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 GARTH RD STE 100
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-3154
Mailing Address - Country:US
Mailing Address - Phone:281-422-3113
Mailing Address - Fax:281-420-3443
Practice Address - Street 1:4201 GARTH RD STE 100
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3154
Practice Address - Country:US
Practice Address - Phone:281-422-3113
Practice Address - Fax:281-420-3443
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX611397363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology