Provider Demographics
NPI:1508075177
Name:SPURLOCK, VICKI DAWN (MSN,APRN,BC)
Entity Type:Individual
Prefix:MISS
First Name:VICKI
Middle Name:DAWN
Last Name:SPURLOCK
Suffix:
Gender:F
Credentials:MSN,APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 MORRIS ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1326
Mailing Address - Country:US
Mailing Address - Phone:304-346-2009
Mailing Address - Fax:
Practice Address - Street 1:139 WOODBRIDGE DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25311-1137
Practice Address - Country:US
Practice Address - Phone:304-346-2009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN57375-FNP-BC363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner