Provider Demographics
NPI:1215912027
Name:WILCOXSON, VICKI L (APRN)
Entity type:Individual
Prefix:MS
First Name:VICKI
Middle Name:L
Last Name:WILCOXSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:785 5TH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-709-6529
Practice Address - Street 1:22 ST PAUL DR
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1036
Practice Address - Country:US
Practice Address - Phone:717-217-6944
Practice Address - Fax:717-303-3729
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007353207RC0000X, 363LA2100X
FLARNP9438475363LA2100X
PARN536557163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA25-1716306OtherDEVON
PA1007307260034OtherMEDICAID GROUP #
PA867633OtherMEDICARE GROUP #
PASP007353OtherLICENSE
PAMW1032729OtherDEA
PAMW1032729OtherDEA