Provider Demographics
NPI:1023063336
Name:MICHENER, VICTORIA L (FNP)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:L
Last Name:MICHENER
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 1:6957 W PLANO PKWY STE 2700
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-1626
Mailing Address - Country:US
Mailing Address - Phone:214-808-3427
Mailing Address - Fax:972-820-9495
Practice Address - Street 1:6957 W PLANO PKWY STE 2700
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-1626
Practice Address - Country:US
Practice Address - Phone:214-808-3427
Practice Address - Fax:972-820-9495
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX510452363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX141155506Medicaid
TX141155507Medicaid
TN89N817OtherBLUECROSS BLUESHIELD
TX141155505Medicaid
TN89N817OtherBLUECROSS BLUESHIELD
TX141155506Medicaid
8L8010Medicare PIN
8L8016Medicare PIN
TX8L8032Medicare PIN