Provider Demographics
NPI:1164612693
Name:WICKER, KAREN KIM (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:KIM
Last Name:WICKER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MRS
Other - First Name:YEON-HUI
Other - Middle Name:KIM
Other - Last Name:WICKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:1127 B 13TH CAVALRY ROAD
Mailing Address - Street 2:
Mailing Address - City:FORT KNOX
Mailing Address - State:KY
Mailing Address - Zip Code:40121-2298
Mailing Address - Country:US
Mailing Address - Phone:575-915-8449
Mailing Address - Fax:
Practice Address - Street 1:150 N EAGLE CREEK DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1805
Practice Address - Country:US
Practice Address - Phone:859-967-5715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704258641367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered