Healthcare Provider Details

I. General information

NPI: 1942820410
Provider Name (Legal Business Name): ASHLEY BROOKE WICKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2020
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST
LEXINGTON KY
40536-4220
US

IV. Provider business mailing address

101 MANNING DRIVE
CHAPEL HILL NC
27599-1772
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-5956
  • Fax: 859-323-1080
Mailing address:
  • Phone: 919-966-5136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number59442
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number59442
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: