Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | OI61230221 | WA |
Y | 222Z00000X | Podiatrist | OI61230221 | WA |
N | 224P00000X | Prosthetist | PS61132736 | WA |
NPI | 1033875240 |
---|---|
Provider Name | Kayla Wicks |
First Address | Onalaska, WA 98570-9529 |
Second Address | Longview, WA 98632-3046 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2021 |
Last Update Date | 11/11/2021 |