Individual
TRACY VICKERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2690 S PEMBROOK AVE, SPRINGFIELD, MO 65807-0910
(417) 230-3728
Mailing address
2690 S PEMBROOK AVE, SPRINGFIELD, MO 65807-0910
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
11/16/2020
Last updated
11/23/2020
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