Provider Demographics
NPI:1669845038
Name:EDWARDS, VICKIE DEE (AGNP-C)
Entity Type:Individual
Prefix:MS
First Name:VICKIE
Middle Name:DEE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:MS
Other - First Name:VICKIE
Other - Middle Name:DEE
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AGNP
Mailing Address - Street 1:23318 NICHOLS SAWMILL RD
Mailing Address - Street 2:
Mailing Address - City:HOCKLEY
Mailing Address - State:TX
Mailing Address - Zip Code:77447-9559
Mailing Address - Country:US
Mailing Address - Phone:713-628-4712
Mailing Address - Fax:
Practice Address - Street 1:9900 BREN RD E
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343-9664
Practice Address - Country:US
Practice Address - Phone:410-274-0596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-08
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX662840363LP2300X
TXAP129732363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care