Provider Demographics
NPI:1689279374
Name:VANN, KACYE MICHELLE (FNP-C)
Entity type:Individual
Prefix:
First Name:KACYE
Middle Name:MICHELLE
Last Name:VANN
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 308
Mailing Address - Street 2:
Mailing Address - City:VALLEY VIEW
Mailing Address - State:TX
Mailing Address - Zip Code:76272-0308
Mailing Address - Country:US
Mailing Address - Phone:940-736-5317
Mailing Address - Fax:
Practice Address - Street 1:903 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-4235
Practice Address - Country:US
Practice Address - Phone:940-336-4584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X
TX1018953363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No133N00000XDietary & Nutritional Service ProvidersNutritionist