Provider Demographics
NPI:1720183692
Name:WATSON, VICKIE LYNN
Entity Type:Individual
Prefix:
First Name:VICKIE
Middle Name:LYNN
Last Name:WATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 64A
Mailing Address - Street 2:14457 N 3650
Mailing Address - City:SASAKWA
Mailing Address - State:OK
Mailing Address - Zip Code:74867-9714
Mailing Address - Country:US
Mailing Address - Phone:405-941-3826
Mailing Address - Fax:405-941-3826
Practice Address - Street 1:RR 1 BOX 64A
Practice Address - Street 2:14457 N 3650
Practice Address - City:SASAKWA
Practice Address - State:OK
Practice Address - Zip Code:74867-9714
Practice Address - Country:US
Practice Address - Phone:405-941-3826
Practice Address - Fax:405-941-3826
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist