Individual
MS. STEPHANIE KAYE VICKERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3595 US HIGHWAY 50, SILVER SPRINGS, NV 89429-9613
(775) 577-2117
(775) 577-2769
Mailing address
1155 MILL ST MS M14, RENO, NV 89502-1576
(775) 982-5262
(775) 982-4196
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2265
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14632500
CAQH ID
NV
01
—
PA2265
PA NEVADA LIC
NV
Enumeration date
08/27/2018
Last updated
06/23/2021
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