Provider Demographics
NPI:1831241553
Name:CLINTON, VICKI ANN
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:ANN
Last Name:CLINTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 WESTOVER DR
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-2808
Mailing Address - Country:US
Mailing Address - Phone:336-802-0345
Mailing Address - Fax:
Practice Address - Street 1:508 WESTOVER DR
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-2808
Practice Address - Country:US
Practice Address - Phone:336-869-3709
Practice Address - Fax:336-869-3709
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC348625376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide