Provider Demographics
NPI:1235959891
Name:QUILANTAN, VICKY LEE (MSN, FNP- BC)
Entity type:Individual
Prefix:
First Name:VICKY
Middle Name:LEE
Last Name:QUILANTAN
Suffix:
Gender:F
Credentials:MSN, FNP- BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1813 GILLHAM DR
Mailing Address - Street 2:
Mailing Address - City:BROWNFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:79316-6013
Mailing Address - Country:US
Mailing Address - Phone:806-786-2634
Mailing Address - Fax:
Practice Address - Street 1:604 KENT ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-5805
Practice Address - Country:US
Practice Address - Phone:432-218-8740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-16
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1177703363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily