Individual
THOMAS A VICKERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
6005 PARK AVE, SUITE 406, MEMPHIS, TN 38119-5202
(901) 682-6282
Mailing address
PO BOX 172104, MEMPHIS, TN 38187-2104
(901) 682-6828
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
APN8876
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00116187
MS MEDICAID
MS
01
—
11683
TLC
TN
01
—
117372
BETTER HEALTH
TN
01
—
2040382
UHC
—
01
—
3028386
B/C
—
01
—
430051284
RR MEDICARE
—
Enumeration date
08/25/2006
Last updated
12/01/2011
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