Provider Demographics
NPI:1427373125
Name:VERNON, VALERIE ANN (PA)
Entity Type:Individual
Prefix:MS
First Name:VALERIE
Middle Name:ANN
Last Name:VERNON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 S 70TH ST
Mailing Address - Street 2:STE 110
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-4282
Mailing Address - Country:US
Mailing Address - Phone:402-489-3834
Mailing Address - Fax:
Practice Address - Street 1:4501 S 70TH ST
Practice Address - Street 2:STE 110
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-4282
Practice Address - Country:US
Practice Address - Phone:402-489-3834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1507363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant