Provider Demographics
NPI:1932346533
Name:VICKERS, SHELLEY LANETTE
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:LANETTE
Last Name:VICKERS
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 1:5380 HIGHWAY 358
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-8619
Mailing Address - Country:US
Mailing Address - Phone:870-565-8582
Mailing Address - Fax:
Practice Address - Street 1:1715 LINWOOD DR
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-5820
Practice Address - Country:US
Practice Address - Phone:870-236-5880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-19
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator