Provider Demographics
NPI:1023241254
Name:VICKERS, CARA CHADBOURNE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:CARA
Middle Name:CHADBOURNE
Last Name:VICKERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:489 BERNARDSTON RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-1238
Mailing Address - Country:US
Mailing Address - Phone:413-325-8500
Mailing Address - Fax:413-772-6866
Practice Address - Street 1:489 BERNARDSTON RD
Practice Address - Street 2:SUITE 108
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-1238
Practice Address - Country:US
Practice Address - Phone:413-325-8500
Practice Address - Fax:413-772-6866
Is Sole Proprietor?:No
Enumeration Date:2009-09-04
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA 3816363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPA3816OtherMASSACHUSETTS STATE LICENSE