Individual
TERESA MICHELE VICKERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
620 E 18TH ST, KANSAS CITY, MO 64108-1510
(816) 554-4246
(816) 554-4350
Mailing address
620 E 18TH ST, KANSAS CITY, MO 64108-1510
Taxonomy
Speciality
Code
Description
License number
State
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
Primary
2012012235
MO
Other
Enumeration date
09/26/2012
Last updated
09/26/2012
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