Provider Demographics
NPI:1154913994
Name:FICKES, VICKI LEE (RN)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:LEE
Last Name:FICKES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 INDUSTRIAL RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:KS
Mailing Address - Zip Code:67063-9602
Mailing Address - Country:US
Mailing Address - Phone:620-947-3114
Mailing Address - Fax:
Practice Address - Street 1:101 INDUSTRIAL RD
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:KS
Practice Address - Zip Code:67063-9602
Practice Address - Country:US
Practice Address - Phone:620-947-3114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-140281163WE0003X, 163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WW0000XNursing Service ProvidersRegistered NurseWound Care