Provider Demographics
NPI:1619172202
Name:CARR, VICKI LAKWANDA (MD)
Entity Type:Individual
Prefix:DR
First Name:VICKI
Middle Name:LAKWANDA
Last Name:CARR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25214 FLEMING MEADOW
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77389
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20311 KUYKENDAHL RD.
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-2614
Practice Address - Country:US
Practice Address - Phone:832-717-3376
Practice Address - Fax:832-717-0004
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP2-0018536207NP0225X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
688161702OtherMYUTMB 688161702-COMMERCIAL NUMBER