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General NPI Number Information
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NPI Number | 1790214989
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Entity Type | Individual
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Provider Name | XAQUITA WICKS FNP-C, MSN, BSN, RN
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Gender | Female
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Dates
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Enumeration Date | 06/09/2017
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Last Update Date | 01/12/2023
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Provider Practice Location Address
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Address Line | 2922B MLK JR BLVD
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City | DALLAS
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State | TX
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Zip | 75215-2321
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Country | US
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Telephone | 214-708-2739
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Fax |
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Provider Business Mailing Address
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Address Line | 1759 BROAD PARK CIR S STE 113
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City | MANSFIELD
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State | TX
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Zip | 76063-7836
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Country | US
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Telephone | 817-473-1312
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1106498
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 847794
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License Number State | TX
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