Provider Demographics
NPI:1578690046
Name:BICKING, WAYDELL B
Entity Type:Individual
Prefix:
First Name:WAYDELL
Middle Name:B
Last Name:BICKING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 PAUL PRESNELL RD
Mailing Address - Street 2:
Mailing Address - City:SUGAR GROVE
Mailing Address - State:NC
Mailing Address - Zip Code:28679-9572
Mailing Address - Country:US
Mailing Address - Phone:828-297-1779
Mailing Address - Fax:
Practice Address - Street 1:1966 MORGANTON BLVD SW STE B
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-5311
Practice Address - Country:US
Practice Address - Phone:828-426-8499
Practice Address - Fax:828-426-8450
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC120985163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC120985OtherNC RN LICENSE NUMBER
NC8300175KMedicaid