Individual
PAULA VICKERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1251 KILAUEA AVE STE 190C, HILO, HI 96720-4293
(808) 961-1000
(808) 961-1000
Mailing address
1635 ONEAWA PL, HILO, HI 96720-5590
(808) 959-8785
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
RN - 40545
HI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
APRN - 742
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000247171
HMSA
HI
05
—
0000551798
—
HI
Enumeration date
11/28/2006
Last updated
12/03/2014
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