Provider Demographics
NPI:1306246194
Name:KENT, VICKI LYNNE (ARNP)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:LYNNE
Last Name:KENT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 W ORCHARD AVE STE A
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-1592
Mailing Address - Country:US
Mailing Address - Phone:541-289-1637
Mailing Address - Fax:541-567-2552
Practice Address - Street 1:955 W ORCHARD AVE STE A
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-1592
Practice Address - Country:US
Practice Address - Phone:541-289-1637
Practice Address - Fax:541-567-2552
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-28
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201405812NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily