Provider Demographics
NPI:1861535205
Name:PICKENS, VICKY LYNN (APRN-BC)
Entity type:Individual
Prefix:
First Name:VICKY
Middle Name:LYNN
Last Name:PICKENS
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:VICKY
Other - Middle Name:LYNN
Other - Last Name:SPIEGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-BC
Mailing Address - Street 1:3828 COUNTY ROAD 124
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:MO
Mailing Address - Zip Code:63621-8889
Mailing Address - Country:US
Mailing Address - Phone:573-546-0144
Mailing Address - Fax:
Practice Address - Street 1:3828 COUNTY ROAD 124
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:MO
Practice Address - Zip Code:63621-8889
Practice Address - Country:US
Practice Address - Phone:573-546-0144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO076592363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO427405808Medicaid
MO427405808Medicaid
MOQ29313Medicare UPIN