Provider Demographics
NPI:1215142393
Name:ARBUCKLE, VICKI S (APRN)
Entity type:Individual
Prefix:MS
First Name:VICKI
Middle Name:S
Last Name:ARBUCKLE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 CARLSON DR
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-5550
Mailing Address - Country:US
Mailing Address - Phone:540-230-0325
Mailing Address - Fax:
Practice Address - Street 1:MCCOMAS HALL
Practice Address - Street 2:WASHINGTON STREET (0108)
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24061-0001
Practice Address - Country:US
Practice Address - Phone:540-231-9840
Practice Address - Fax:540-231-2104
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164807363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health