Provider Demographics
NPI:1679657480
Name:DEKAY, VICKI JEAN
Entity Type:Individual
Prefix:MS
First Name:VICKI
Middle Name:JEAN
Last Name:DEKAY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:VICKI
Other - Middle Name:JEAN
Other - Last Name:BRYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 ALVARES
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95833-1143
Mailing Address - Country:US
Mailing Address - Phone:916-359-5073
Mailing Address - Fax:
Practice Address - Street 1:5700 WATT AVE
Practice Address - Street 2:PPMM NORTH HIGHLANDS
Practice Address - City:NORTH HIGHLANDS
Practice Address - State:CA
Practice Address - Zip Code:95660
Practice Address - Country:US
Practice Address - Phone:916-332-5715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3030363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner