Provider Demographics
NPI:1831677921
Name:VICKROY, KATHLEEN BECHT (FNP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:BECHT
Last Name:VICKROY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S CODY RD
Mailing Address - Street 2:
Mailing Address - City:LE CLAIRE
Mailing Address - State:IA
Mailing Address - Zip Code:52753-9579
Mailing Address - Country:US
Mailing Address - Phone:563-421-9740
Mailing Address - Fax:563-421-9759
Practice Address - Street 1:200 S CODY RD
Practice Address - Street 2:
Practice Address - City:LE CLAIRE
Practice Address - State:IA
Practice Address - Zip Code:52753-9579
Practice Address - Country:US
Practice Address - Phone:563-421-9740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA150966363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily