Individual
JENNIFER VICKERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
313 E 12TH ST, STE 100, AUSTIN, TX 78701-1954
(512) 324-9650
Mailing address
313 E 12TH ST, STE 100, AUSTIN, TX 78701-1954
(512) 324-9650
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
P8626
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
337718601
—
TX
Enumeration date
05/19/2009
Last updated
11/19/2014
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