Provider Demographics
NPI:1659319291
Name:WICKER, CHERYL A (FNP)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:A
Last Name:WICKER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2920 TAVISTOCK DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27712-1047
Mailing Address - Country:US
Mailing Address - Phone:919-383-5818
Mailing Address - Fax:336-226-5894
Practice Address - Street 1:214 E ELM ST
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:NC
Practice Address - Zip Code:27253-3022
Practice Address - Country:US
Practice Address - Phone:336-226-2448
Practice Address - Fax:336-226-5894
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200705363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8925753Medicaid
NC2594406AMedicare PIN
NC8925753Medicaid