Provider Demographics
NPI:1083924534
Name:VICKNAIR, ASHLEY CATHERINE (CPNP)
Entity type:Individual
Prefix:MISS
First Name:ASHLEY
Middle Name:CATHERINE
Last Name:VICKNAIR
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 BOLTON ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-3929
Mailing Address - Country:US
Mailing Address - Phone:512-797-7568
Mailing Address - Fax:
Practice Address - Street 1:180 JOE WIMBERLEY BLVD STE 102
Practice Address - Street 2:
Practice Address - City:WIMBERLEY
Practice Address - State:TX
Practice Address - Zip Code:78676-6083
Practice Address - Country:US
Practice Address - Phone:512-847-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX691127363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics