Provider Demographics
NPI:1386113306
Name:VICKERS, CAROLINE (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:VICKERS
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 COLLINGWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22308-1729
Mailing Address - Country:US
Mailing Address - Phone:609-203-2385
Mailing Address - Fax:
Practice Address - Street 1:RADAR US ARMY HEALTH CLINIC
Practice Address - Street 2:401 CARPENTER ROAD
Practice Address - City:FORT MYER
Practice Address - State:VA
Practice Address - Zip Code:22211
Practice Address - Country:US
Practice Address - Phone:703-696-3032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-20
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant