Provider Demographics
NPI:1104882034
Name:BUXKEMPER, VICKI (FNP)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:BUXKEMPER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5219 CITY BANK PKWY
Mailing Address - Street 2:STE 35
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-3544
Mailing Address - Country:US
Mailing Address - Phone:806-785-7676
Mailing Address - Fax:806-785-7685
Practice Address - Street 1:113 WALNUT ST
Practice Address - Street 2:
Practice Address - City:IDALOU
Practice Address - State:TX
Practice Address - Zip Code:79329-4003
Practice Address - Country:US
Practice Address - Phone:806-892-2537
Practice Address - Fax:806-892-2726
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX581719363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111998401Medicaid
TX111998401Medicaid
P1183Medicare UPIN