Provider Demographics
NPI:1821050196
Name:ZELLER, VICKIE MARIE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:VICKIE
Middle Name:MARIE
Last Name:ZELLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11301 N T QUARTER CIR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86315
Mailing Address - Country:US
Mailing Address - Phone:928-848-8865
Mailing Address - Fax:
Practice Address - Street 1:1001 DIVISION ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1618
Practice Address - Country:US
Practice Address - Phone:928-445-4818
Practice Address - Fax:928-445-4837
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ3783OtherSTATE LICENSE
AZ788372Medicaid
AZZ183308OtherMEDICARE PTAN