| Doctor Name: | AMY WICKE |
| NPI Number: | 1568465722 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | PA04282 |
| Business Practice Address: | 1302 S St Marys St Falfurrias, TX - 783555034 |
| Business Phone Number: | 3613259404 |
| Business Fax Number: | 3613259564 |
| Mailing Address: | 204 E 1st St, ALICE |
| State: | TX |
| Postal Code: | 783324822 |
| Phone Number: | 3616640145 |
| Fax Number: | 3616642248 |
| NPI Enumeration Date: | 05/23/2005 |
| NPI Last Update Date: | 03/11/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA04282 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |