Provider Demographics
NPI:1770971061
Name:VICKERS, HAYLEY RENE (CRNA, DNP-A)
Entity type:Individual
Prefix:MRS
First Name:HAYLEY
Middle Name:RENE
Last Name:VICKERS
Suffix:
Gender:F
Credentials:CRNA, DNP-A
Other - Prefix:MISS
Other - First Name:HAYLEY
Other - Middle Name:RENE
Other - Last Name:GRIFFIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 650865
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0865
Mailing Address - Country:US
Mailing Address - Phone:972-715-5000
Mailing Address - Fax:972-715-9976
Practice Address - Street 1:6606 LBJ FWY
Practice Address - Street 2:SUITE 200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6533
Practice Address - Country:US
Practice Address - Phone:972-715-9976
Practice Address - Fax:972-715-9976
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-08
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX770464163W00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8341UKOtherBCBS
TX343065402Medicaid
TX391604YK6UMedicare PIN