Provider Demographics
NPI:1710511019
Name:BORTZER, VICKI (DNP)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:BORTZER
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:VICKI
Other - Middle Name:
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 COMMODORE ST
Mailing Address - Street 2:
Mailing Address - City:PRATT
Mailing Address - State:KS
Mailing Address - Zip Code:67124-2903
Mailing Address - Country:US
Mailing Address - Phone:620-450-1186
Mailing Address - Fax:
Practice Address - Street 1:124 COMMODORE ST STE B
Practice Address - Street 2:
Practice Address - City:PRATT
Practice Address - State:KS
Practice Address - Zip Code:67124-2995
Practice Address - Country:US
Practice Address - Phone:620-672-6454
Practice Address - Fax:620-672-3488
Is Sole Proprietor?:No
Enumeration Date:2020-02-25
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS79498363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily