Provider Demographics
NPI:1700366176
Name:WATERS, VICKI LYNN (PA)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:LYNN
Last Name:WATERS
Suffix:
Gender:F
Credentials:PA
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Other - Last Name:
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Mailing Address - Street 1:ONE BAYLOR PLAZA, MS: BCM115
Mailing Address - Street 2:DEBAKEY BLDG., ROOM M108
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:713-798-8556
Mailing Address - Fax:713-798-6128
Practice Address - Street 1:ONE BAYLOR PLAZA, MS: BCM115
Practice Address - Street 2:DEBAKEY BLDG., ROOM M108
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:713-798-8556
Practice Address - Fax:713-798-6128
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA02149363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant