Provider Demographics
NPI:1093219834
Name:WYKER, ANDREW WILLIAM (DO)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:WILLIAM
Last Name:WYKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:566 RUIN CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536
Mailing Address - Country:US
Mailing Address - Phone:252-436-1352
Mailing Address - Fax:252-436-1351
Practice Address - Street 1:566 RUIN CREEK RD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-2927
Practice Address - Country:US
Practice Address - Phone:252-436-1352
Practice Address - Fax:252-436-1351
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2020-04496207R00000X
VAVA0116031666207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine