Provider Demographics
NPI:1790438646
Name:VICKERS, CYNTHIA GAIL
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:GAIL
Last Name:VICKERS
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 1:9354 DANIEL BOONE PKWY
Mailing Address - Street 2:
Mailing Address - City:FOSTER
Mailing Address - State:WV
Mailing Address - Zip Code:25081
Mailing Address - Country:US
Mailing Address - Phone:304-784-0658
Mailing Address - Fax:
Practice Address - Street 1:9354 DANIEL BOONE PKWY
Practice Address - Street 2:
Practice Address - City:FOSTER
Practice Address - State:WV
Practice Address - Zip Code:25081
Practice Address - Country:US
Practice Address - Phone:304-784-0658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator