Basic Information
| Provider Information | |||||||||
| NPI: | 1649525932 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | VICKY | ||||||||
| MiddleName: | KILLEN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 440210 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372440210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158243737 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 505 SAMARITANS RIDGE CT | ||||||||
| Address2: | |||||||||
| City: | ELKIN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286212457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365261181 | ||||||||
| FaxNumber: | 3365261807 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2012 | ||||||||
| LastUpdateDate: | 03/07/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F0612213 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 5005715 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | NC8568A | 01 | NC | MEDICARE PTAN, INDIVIDUAL | OTHER | 2335816 | 01 | NC | MEDICARE PTAN, GROUP WILKES | OTHER |