Provider Demographics
NPI:1295711893
Name:VERNON, VICKI L (ARNP)
Entity type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:L
Last Name:VERNON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 398
Mailing Address - Street 2:BOYLE CO HEALTH DEPT
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40423-0398
Mailing Address - Country:US
Mailing Address - Phone:859-236-2053
Mailing Address - Fax:859-236-2863
Practice Address - Street 1:448 SOUTH 3RD ST
Practice Address - Street 2:BOYLE CO HEALTH DEPT
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422
Practice Address - Country:US
Practice Address - Phone:859-236-2053
Practice Address - Fax:859-236-2863
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYARNP2847P363LW0102X
KYRN1033544363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY20011011Medicaid
0280102Medicare ID - Type Unspecified
KY20011011Medicaid