Provider Demographics
NPI:1740757004
Name:VICKERS, SHAYLYN DIANE (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:SHAYLYN
Middle Name:DIANE
Last Name:VICKERS
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:SHAYLYN
Other - Middle Name:DIANE
Other - Last Name:WEBSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-2222
Mailing Address - Fax:614-293-4162
Practice Address - Street 1:1800 ZOLLINGER RD FL 4
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-2800
Practice Address - Country:US
Practice Address - Phone:614-293-2222
Practice Address - Fax:614-293-4162
Is Sole Proprietor?:No
Enumeration Date:2018-10-25
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.022791207Q00000X, 207V00000X, 363LX0001X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology