Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | ||
N | 222Z00000X | Podiatrist | ||
Y | 224P00000X | Prosthetist |
NPI | 1457567752 |
---|---|
Provider Name | Kevin A Wicker |
First Address | Morganton, NC 28655-4097 |
Second Address | Morganton, NC 28655-4097 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2007 |
Last Update Date | 08/05/2017 |