Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP138232 | TX |
NPI | 1013494566 |
---|---|
Provider Name | Mr. Matthew Aaron Vickers |
First Address | Plano, TX 75024-3377 |
Second Address | Plano, TX 75024-3377 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2018 |
Last Update Date | 04/03/2020 |