Individual
VINCENT MICHAEL PROCTOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
775F WEATHERLY DR, CLARKSVILLE, TN 37043-8942
(931) 494-7131
Mailing address
775 WEATHERLY DR STE F, CLARKSVILLE, TN 37043-8915
(931) 494-7131
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4148
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1151163
NCCPA
—
01
—
4148
TN DEPT OF HEALTH
TN
Enumeration date
03/16/2018
Last updated
03/07/2023
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