Provider Demographics
NPI:1629771472
Name:EDWARDS, VICKIE DIANE
Entity Type:Individual
Prefix:
First Name:VICKIE
Middle Name:DIANE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 WELLER LN
Mailing Address - Street 2:
Mailing Address - City:BRINKLEY
Mailing Address - State:AR
Mailing Address - Zip Code:72021-7016
Mailing Address - Country:US
Mailing Address - Phone:870-589-3188
Mailing Address - Fax:
Practice Address - Street 1:127 WELLER LN
Practice Address - Street 2:
Practice Address - City:BRINKLEY
Practice Address - State:AR
Practice Address - Zip Code:72021-7016
Practice Address - Country:US
Practice Address - Phone:870-589-3188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider