Provider Demographics
NPI:1124053632
Name:VAIANI, VIKKI LEE (MSNAPRNBC)
Entity type:Individual
Prefix:MS
First Name:VIKKI
Middle Name:LEE
Last Name:VAIANI
Suffix:
Gender:F
Credentials:MSNAPRNBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24165 IH 10 W STE 217-743
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-1449
Mailing Address - Country:US
Mailing Address - Phone:210-844-0538
Mailing Address - Fax:210-934-2058
Practice Address - Street 1:12952 BANDERA RD STE 105
Practice Address - Street 2:
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-4690
Practice Address - Country:US
Practice Address - Phone:210-844-0538
Practice Address - Fax:210-934-2058
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX446681363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX088299501Medicaid