MEDICARE: WRENN ELIZABETH WICKS

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
1	390200000X	Student in an Organized Health Care Education/Training Program		TN

General Provider Information

NPI Number	:	1902747637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WRENN ELIZABETH WICKS

Provider Business Mailing Address
First Line	:	8170 N TWISTED OAK DR
Second Line	:
City	:	MARTINSVILLE
State	:	IN
Zip	:	46151-5919
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2311 PIERCE AVE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37232-0025
Country	:	US
Telephone Number	:	615-936-2020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	04/06/2026

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