Provider Demographics
NPI:1649277138
Name:FOX, VICKI JAN (RN, ACNP-CS)
Entity type:Individual
Prefix:MS
First Name:VICKI
Middle Name:JAN
Last Name:FOX
Suffix:
Gender:F
Credentials:RN, ACNP-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 ROSE RD
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-4739
Mailing Address - Country:US
Mailing Address - Phone:903-592-2569
Mailing Address - Fax:903-533-9252
Practice Address - Street 1:800 E DAWSON ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2036
Practice Address - Country:US
Practice Address - Phone:903-592-2569
Practice Address - Fax:903-533-9252
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX232779363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care