Individual
VICKI MCKISSICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2131 MURFREESBORO PIKE STE 210, NASHVILLE, TN 37217-6306
(615) 715-1182
Mailing address
2131 MURFREESBORO PIKE STE 210, NASHVILLE, TN 37217-6306
(615) 715-1182
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
L000000017408
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
QO21777
—
TN
Enumeration date
10/22/2018
Last updated
10/22/2018
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