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NPI Code Detail

MEDICARE: AMY BROOKE WICKER FNP

MEDICARE: AMY BROOKE WICKER FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner222677OK

General Provider Information

NPI Number : 1215730379
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY BROOKE WICKER FNP
Provider Business Mailing Address
First Line : 701 E OLIVIA TER
Second Line :
City : MUSTANG
State : OK
Zip : 73064-4839
Country : US
Telephone Number : 405-250-0789
Fax Number :
Provider Business Practice Location Address
First Line : 5101 W MEMORIAL RD
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73142-2018
Country : US
Telephone Number : 405-463-5700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2025
Last Update Date : 03/31/2025

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