Provider Demographics
NPI:1104133305
Name:BARRETT, VICKIE SUSAN (CRNP)
Entity type:Individual
Prefix:
First Name:VICKIE
Middle Name:SUSAN
Last Name:BARRETT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4425 OVERLOOK RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35222-3745
Mailing Address - Country:US
Mailing Address - Phone:205-595-1166
Mailing Address - Fax:
Practice Address - Street 1:39 HANOVER CIR S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1703
Practice Address - Country:US
Practice Address - Phone:205-933-1828
Practice Address - Fax:205-933-0900
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-048030363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health