Provider Demographics
NPI:1619280229
Name:FLEMMING, VICKERY WANTY
Entity type:Individual
Prefix:MRS
First Name:VICKERY
Middle Name:WANTY
Last Name:FLEMMING
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:VICKY
Other - Middle Name:WANTY
Other - Last Name:FLEMMING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1875 AVERY WAY
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-3717
Mailing Address - Country:US
Mailing Address - Phone:303-862-5149
Mailing Address - Fax:
Practice Address - Street 1:2530 S PARKER RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1623
Practice Address - Country:US
Practice Address - Phone:303-614-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-23
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO44001163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse