Provider Demographics
NPI:1558688440
Name:UMPHREY, VICKI E (ARNP)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:E
Last Name:UMPHREY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:E
Other - Last Name:UMPHREY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:1387 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-9766
Mailing Address - Country:US
Mailing Address - Phone:918-549-0024
Mailing Address - Fax:
Practice Address - Street 1:1387 W 4TH ST
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-9766
Practice Address - Country:US
Practice Address - Phone:918-549-0024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-01
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0065493363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily