Provider Demographics
NPI:1659346690
Name:KRAL, VICKI JAYME (BHP)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:JAYME
Last Name:KRAL
Suffix:
Gender:F
Credentials:BHP
Other - Prefix:
Other - First Name:VICKI
Other - Middle Name:JAYME
Other - Last Name:LUNDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:642 DAMERON DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-2411
Mailing Address - Country:US
Mailing Address - Phone:928-445-5211
Mailing Address - Fax:928-776-8484
Practice Address - Street 1:345 N WINDSONG
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314
Practice Address - Country:US
Practice Address - Phone:928-445-5211
Practice Address - Fax:928-776-8484
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC11705101YP2500X
AZRN030323163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health