| Doctor Name: | MRS. CHRISHAUNDA LAKEISH VICK |
| NPI Number: | 1003299561 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP-C |
| License Number: | 5007728 |
| Business Practice Address: | 7900 Old Wake Forest Rd Raleigh, NC - 276163319 |
| Business Phone Number: | 8663892727 |
| Business Fax Number: | |
| Mailing Address: | 8312 Boca Point, RALEIGH |
| State: | NC |
| Postal Code: | 27616 |
| Phone Number: | 9199236476 |
| Fax Number: | |
| NPI Enumeration Date: | 07/02/2015 |
| NPI Last Update Date: | 05/26/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 5007728 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |