Provider Demographics
NPI:1235944513
Name:BROCKMAN, VICKIE LANE (BA)
Entity type:Individual
Prefix:
First Name:VICKIE
Middle Name:LANE
Last Name:BROCKMAN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4341 S HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-6105
Mailing Address - Country:US
Mailing Address - Phone:606-772-1030
Mailing Address - Fax:
Practice Address - Street 1:4341 S HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-6105
Practice Address - Country:US
Practice Address - Phone:606-772-1030
Practice Address - Fax:606-451-0558
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator