Healthcare Provider Details

I. General information

NPI: 1740585603
Provider Name (Legal Business Name): ANGELA LYNN WICKS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2011
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21165 LAST CHANCE RIDGE RD
DEADWOOD SD
57732-7303
US

IV. Provider business mailing address

21165 LAST CHANCE RIDGE RD
DEADWOOD SD
57732-7303
US

V. Phone/Fax

Practice location:
  • Phone: 515-971-5162
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA-095302
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: