Provider Demographics
NPI:1457577934
Name:VICKERS, REBECCA JEAN (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:JEAN
Last Name:VICKERS
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 DOWDY FERRY RD
Mailing Address - Street 2:
Mailing Address - City:HUTCHINS
Mailing Address - State:TX
Mailing Address - Zip Code:75141-4027
Mailing Address - Country:US
Mailing Address - Phone:214-371-0474
Mailing Address - Fax:217-371-3933
Practice Address - Street 1:3330 S LANCASTER RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-4531
Practice Address - Country:US
Practice Address - Phone:214-371-0474
Practice Address - Fax:214-371-3933
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX654073163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult