Individual
SAMANTHA SHORTER VICKREY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
3451 GOODMAN RD E STE 115, SOUTHAVEN, MS 38672
(662) 890-5555
Mailing address
3451 GOODMAN RD E STE 115, SOUTHAVEN, MS 38672-9304
(662) 890-5555
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
A004573
AR
Other
Enumeration date
12/01/2015
Last updated
03/27/2019
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