Provider Demographics
NPI:1679548176
Name:FOLEY, VERA KATHRYN (NP)
Entity type:Individual
Prefix:
First Name:VERA
Middle Name:KATHRYN
Last Name:FOLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1813 WILLOW ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-4276
Mailing Address - Country:US
Mailing Address - Phone:812-885-8941
Mailing Address - Fax:812-885-8940
Practice Address - Street 1:1813 WILLOW ST
Practice Address - Street 2:SUITE 3
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-4276
Practice Address - Country:US
Practice Address - Phone:812-885-8941
Practice Address - Fax:812-885-8940
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000975A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200520010Medicaid
P34109Medicare UPIN
IN258190030Medicare PIN