Provider Demographics
NPI:1366582678
Name:DENNIS, VICKI L
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:L
Last Name:DENNIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18115 HIGHWAY 69
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-7723
Mailing Address - Country:US
Mailing Address - Phone:205-221-2745
Mailing Address - Fax:205-387-7739
Practice Address - Street 1:18115 HIGHWAY 69
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-7723
Practice Address - Country:US
Practice Address - Phone:205-221-2745
Practice Address - Fax:205-387-7739
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4461744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51511577OtherBLUE CROSS BLUE SHIELD
AL4614090001Medicare ID - Type Unspecified