Provider Demographics
NPI:1972187995
Name:KACYE M VANN NURSE PRACTITIONER
Entity Type:Organization
Organization Name:KACYE M VANN NURSE PRACTITIONER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KACYE
Authorized Official - Middle Name:M
Authorized Official - Last Name:VANN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:940-641-3440
Mailing Address - Street 1:1615 HOSPITAL BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76240-2032
Mailing Address - Country:US
Mailing Address - Phone:940-641-3440
Mailing Address - Fax:940-641-3553
Practice Address - Street 1:1615 HOSPITAL BLVD STE A
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-2032
Practice Address - Country:US
Practice Address - Phone:940-641-3440
Practice Address - Fax:940-641-3553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty