| Doctor Name: | VICKY ST JOHN |
| NPI Number: | 1033580394 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN |
| License Number: | AP129324 |
| Business Practice Address: | 315 W Houston St Jasper, TX - 759514013 |
| Business Phone Number: | 4093843430 |
| Business Fax Number: | 4093831054 |
| Mailing Address: | 315 W Houston St, JASPER |
| State: | TX |
| Postal Code: | 759514013 |
| Phone Number: | 4093843430 |
| Fax Number: | 4093831054 |
| NPI Enumeration Date: | 10/13/2015 |
| NPI Last Update Date: | 10/27/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | AP129324 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |