Provider Demographics
NPI:1194090134
Name:THREADGILL, VICKI RENEE (APRN NNP BC)
Entity type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:RENEE
Last Name:THREADGILL
Suffix:
Gender:F
Credentials:APRN NNP BC
Other - Prefix:
Other - First Name:VICKI
Other - Middle Name:RENEE
Other - Last Name:MONTGOMERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN NNP BC
Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:405-949-3393
Mailing Address - Fax:405-945-5493
Practice Address - Street 1:3300 NW EXPRESSWAY
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4418
Practice Address - Country:US
Practice Address - Phone:405-949-3393
Practice Address - Fax:405-945-5493
Is Sole Proprietor?:No
Enumeration Date:2012-03-08
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK52055363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal