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Individual

CHAD RANDAL VICKERS

Active
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Individual

CHAD RANDAL VICKERS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PMHNP

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
706002
TX
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
6371
MN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
706002
TX
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
L8-0000171
DE

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1780753681
—
MN
05
—
182997001
—
TX
05
—
182997003
—
TX
05
—
200101760A
—
OK
01
—
868N62
BCBS
TX
01
—
P01078815
RAILROAD MEDICARE
TX
Enumeration date
11/06/2006
Last updated
04/22/2020
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