Provider Demographics
NPI:1891206645
Name:STEVENS, VICKIE LYNNE (FNP)
Entity Type:Individual
Prefix:
First Name:VICKIE
Middle Name:LYNNE
Last Name:STEVENS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1048 TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-4138
Mailing Address - Country:US
Mailing Address - Phone:276-783-1827
Mailing Address - Fax:276-783-2879
Practice Address - Street 1:5296 REDBUD HWY
Practice Address - Street 2:
Practice Address - City:HONAKER
Practice Address - State:VA
Practice Address - Zip Code:24260-7379
Practice Address - Country:US
Practice Address - Phone:276-991-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA002417557363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily