Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | RN190291 | GA |
NPI | 1154087997 |
---|---|
Provider Name | Mrs. Vickie Lynn Jumper |
First Address | Buford, GA 30518-8776 |
Second Address | Buford, GA 30518-8776 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2021 |
Last Update Date | 16/11/2021 |