Provider Demographics
NPI:1548819477
Name:VICK, CHRISTI LEA (MSN, APRN, AGNP-CNP)
Entity type:Individual
Prefix:
First Name:CHRISTI
Middle Name:LEA
Last Name:VICK
Suffix:
Gender:F
Credentials:MSN, APRN, AGNP-CNP
Other - Prefix:
Other - First Name:CHRISTI
Other - Middle Name:LEA
Other - Last Name:VENTRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:704 AZALEA HILL DR
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-6504
Mailing Address - Country:US
Mailing Address - Phone:405-747-4835
Mailing Address - Fax:405-467-4417
Practice Address - Street 1:704 AZALEA HILL DR
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-6504
Practice Address - Country:US
Practice Address - Phone:405-747-4835
Practice Address - Fax:405-467-4417
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-04
Last Update Date:2019-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK109643261QU0200X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care