Individual ProviderVicki J CarlsonNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address3600 Joseph Siewick Dr, Fairfax, VA 22033-1709(703) 391-3600(703) 766-9737PECOS EnrollmentBased on the most recent information from CMS, provider Vicki J Carlson does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 9:15 AM.Profile DetailsProvider ID1144315953Provider TypeIndividualFull NameCarlson, Vicki JTitleMs.CredentialCRNAGenderFemaleSole ProprietorNoEnumeration Date10/4/2006Last Updated4/23/2015Contact InformationPractice LocationPractice Address3600 Joseph Siewick Dr, Fairfax, VA 22033-1709Phone(703) 391-3600FaxUnlisted FaxMailing LocationMailing Address3998 Fair Ridge Dr, Ste 300, Fairfax, VA 22033-2921Phone(703) 766-9737Fax(703) 766-9725Provider TaxonomiesCodeDescriptionLicenseCode367500000XPrimaryDescriptionNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing ProvidersLicense0024166330VirginiaProvider IdentifiersIDDescriptionIssuerID301907DescriptionOtherIssuerAMERIGROUPVirginiaIDK142-0002DescriptionOtherIssuerCAREFIRSTDistrict of ColumbiaID139180DescriptionOtherIssuerANTHEMVirginiaID484645DescriptionOtherIssuerNCPPOVirginiaID1144315953DescriptionMedicaidIssuerUnlistedVirginiaIDP00313213DescriptionOtherIssuerRAILROAD MEDICAREVirginia