Taylor Vickers, PA-C
Physician Assistant in Nampa, ID. Individual provider (NPI-1).
NPI number1164046702
StatusActive
Last updated in NPPESJan 9, 2025
Details
- NPI
- 1164046702
- Entity type
- Individual (NPI-1)
- Name
- Taylor Vickers
- Credential
- PA-C
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- May 29, 2020
- Certification date
- Jan 9, 2025
- Last updated
- Jan 9, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | 4161079 | ID | Yes |
| 146N00000X | Emergency Medical Technician, Basic | 745200 | TX | |
| 363A00000X | Physician Assistant | PA13966 | TX | |
| 363AM0700X | Physician Assistant, Medical | PA13966 | TX |
Practice location
9850 W St Lukes DrNampa, ID 83687-7912
Phone 208-205-7282 · Fax 208-205-7591
Mailing address
190 E Bannock StBoise, ID 83712-6241
Other practice locations
6720 Bertner Ave
Houston, TX 77030-2604
Houston, TX 77030-2604
Phone 832-355-1000
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