Individual
TERESA S VICKERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1860 WATSON BLVD, WARNER ROBINS, GA 31093-3612
(478) 225-9001
(478) 225-9167
Mailing address
2929 WATSON BLVD STE 2, WARNER ROBINS, GA 31093-9601
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
RN149574
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AG05170061
GEORGIA CERTIFICATION (NP)
GA
01
—
RN149574
RN LICENSURE
GA
Enumeration date
05/22/2017
Last updated
05/22/2017
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