Provider Demographics
NPI:1982205449
Name:ZICKEFOOSE, VANESSA LYNN (APRN-CNP)
Entity Type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:LYNN
Last Name:ZICKEFOOSE
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4415 S HARVARD AVE STE 209
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2618
Mailing Address - Country:US
Mailing Address - Phone:539-202-1585
Mailing Address - Fax:539-202-1588
Practice Address - Street 1:4415 S HARVARD AVE STE 209
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2618
Practice Address - Country:US
Practice Address - Phone:539-202-1585
Practice Address - Fax:539-202-1588
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-02
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OKR0123057363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily