Provider Demographics
NPI:1588621403
Name:GRIFFITH, VICKIE LYNN (CRNP)
Entity Type:Individual
Prefix:
First Name:VICKIE
Middle Name:LYNN
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4212 CARMICHAEL CT N
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-3621
Mailing Address - Country:US
Mailing Address - Phone:334-213-8804
Mailing Address - Fax:334-213-8815
Practice Address - Street 1:4212 CARMICHAEL CT N
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-3621
Practice Address - Country:US
Practice Address - Phone:334-213-8804
Practice Address - Fax:334-213-8815
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-039007363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALS27877Medicare UPIN