Provider Demographics
NPI:1730170424
Name:ROOME, VICKI Y (CRNP)
Entity type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:Y
Last Name:ROOME
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 MOUNTAIN LAUREL
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28805-9764
Mailing Address - Country:US
Mailing Address - Phone:215-290-9383
Mailing Address - Fax:
Practice Address - Street 1:1100 TUNNEL RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28805-2043
Practice Address - Country:US
Practice Address - Phone:828-398-7911
Practice Address - Fax:828-299-2573
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP006220C363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P74852Medicare UPIN
064310Medicare ID - Type Unspecified