Provider Demographics
NPI:1649525932
Name:ANDERSON, VICKY KILLEN (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:VICKY
Middle Name:KILLEN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:FNP-C
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 440210
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37244-0210
Mailing Address - Country:US
Mailing Address - Phone:615-824-3737
Mailing Address - Fax:
Practice Address - Street 1:505 SAMARITANS RIDGE CT
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-2457
Practice Address - Country:US
Practice Address - Phone:336-526-1181
Practice Address - Fax:336-526-1807
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCF0612213363LF0000X
NC5005715363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC8568AOtherMEDICARE PTAN, INDIVIDUAL
NC2335816OtherMEDICARE PTAN, GROUP WILKES