Doctor Name: | MISS ASHLEY CATHERINE VICKNAIR |
NPI Number: | 1083924534 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CPNP |
License Number: | 691127 |
Business Practice Address: | 180 Joe Wimberley Blvd Ste 102 Wimberley, TX - 786766083 |
Business Phone Number: | 5128477700 |
Business Fax Number: | |
Mailing Address: | 2601 Bolton St, AUSTIN |
State: | TX |
Postal Code: | 787483929 |
Phone Number: | 5127977568 |
Fax Number: | |
NPI Enumeration Date: | 10/18/2010 |
NPI Last Update Date: | 10/18/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP0200X |
License Number: | 691127 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Pediatrics |
Taxonomy Definition: |