Provider Demographics
NPI:1619452372
Name:HAMMONS, VICKI DAWN (APRN (STUDENT))
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:DAWN
Last Name:HAMMONS
Suffix:
Gender:F
Credentials:APRN (STUDENT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14502 S TOLEDO PL
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-8016
Mailing Address - Country:US
Mailing Address - Phone:918-724-5793
Mailing Address - Fax:
Practice Address - Street 1:20 E 34TH ST
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-4001
Practice Address - Country:US
Practice Address - Phone:918-245-9675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-28
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK66643163WE0003X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency