Individual
KENNETH VICKERS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
100 HILLCREST MEDICAL BLVD, WACO, TX 76712-8897
(254) 230-1509
Mailing address
PO BOX 84891, DALLAS, TX 75284-8491
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AP121629
TX
Other
Enumeration date
12/16/2011
Last updated
04/11/2025
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