Provider Demographics
NPI:1770545899
Name:HISLE, VICKI L (MSN, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:L
Last Name:HISLE
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 SOLAR DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:KY
Mailing Address - Zip Code:40456-6499
Mailing Address - Country:US
Mailing Address - Phone:606-256-8362
Mailing Address - Fax:
Practice Address - Street 1:890 RICHMOND PLZ
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2564
Practice Address - Country:US
Practice Address - Phone:859-623-5155
Practice Address - Fax:859-623-9924
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3630P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP44042Medicare UPIN