Provider Demographics
NPI:1992896856
Name:CLIFTON, VICKI L (CRNA)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:L
Last Name:CLIFTON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50720
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79159-0720
Mailing Address - Country:US
Mailing Address - Phone:806-467-0459
Mailing Address - Fax:806-355-1284
Practice Address - Street 1:7310 FLEMING AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1807
Practice Address - Country:US
Practice Address - Phone:806-354-8891
Practice Address - Fax:806-354-2591
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX245526367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89088UOtherBCBSTX
TX145040502Medicaid
TX84789UOtherBLUE CROSS & BLUE SHIELD
TX8K7231Medicare PIN
TX84789UOtherBLUE CROSS & BLUE SHIELD