Individual
LYNAUDRY VICKERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
202 NW 13TH AVE, PORTLAND, OR 97209-2953
(503) 684-8252
Mailing address
202 NW 13TH AVE, PORTLAND, OR 97209-2953
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
201902562RN
OR
171M00000X
Case Manager/Care Coordinator
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
202008402NP-PP
OR
Other
Enumeration date
07/23/2019
Last updated
09/23/2020
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