Provider Demographics
NPI:1023069903
Name:SCONYERS, VICKIE D (CRNP)
Entity type:Individual
Prefix:
First Name:VICKIE
Middle Name:D
Last Name:SCONYERS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 WEST MAIN ST
Mailing Address - Street 2:STE 31
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-4300
Mailing Address - Country:US
Mailing Address - Phone:334-793-6511
Mailing Address - Fax:334-677-5642
Practice Address - Street 1:4300 WEST MAIN ST
Practice Address - Street 2:WOMENS HEALTHCARE OF DOTHAN PC STE 31
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-4300
Practice Address - Country:US
Practice Address - Phone:334-793-6511
Practice Address - Fax:334-677-5642
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1029189363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000029327Medicaid
S49905Medicare UPIN
AL000029327Medicaid