Provider Demographics
NPI:1982622965
Name:HOLLAND, VICKIE GAYLIN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:VICKIE
Middle Name:GAYLIN
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MISS
Other - First Name:VICKIE
Other - Middle Name:GAYLIN
Other - Last Name:PRATER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1514 E. JOSEPH LANE
Mailing Address - Street 2:
Mailing Address - City:FORT GIBSON
Mailing Address - State:OK
Mailing Address - Zip Code:74434-8314
Mailing Address - Country:US
Mailing Address - Phone:918-478-3045
Mailing Address - Fax:918-478-3045
Practice Address - Street 1:1011 HONOR HEIGHTS DR.
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-1318
Practice Address - Country:US
Practice Address - Phone:918-683-3261
Practice Address - Fax:918-680-3664
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0032046363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKROO32046OtherLICENSE NUMBER
OKROO32046OtherLICENSE NUMBER
OKROO32046OtherLICENSE NUMBER