Provider Demographics
NPI:1003098963
Name:VICK, ROSE B (ARNP)
Entity type:Individual
Prefix:MS
First Name:ROSE
Middle Name:B
Last Name:VICK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5300 MARYLAND WAY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5074
Mailing Address - Country:US
Mailing Address - Phone:615-224-9800
Mailing Address - Fax:615-224-9840
Practice Address - Street 1:5300 MARYLAND WAY
Practice Address - Street 2:SUITE 103
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5074
Practice Address - Country:US
Practice Address - Phone:615-224-9800
Practice Address - Fax:615-224-9840
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2024-12-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNAPN17121363LP0808X
KY5409P363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5409POtherKY LICENSE