Provider Demographics
NPI:1720719735
Name:WICKER, CARA (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:
Last Name:WICKER
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 SOUTH BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-3717
Mailing Address - Country:US
Mailing Address - Phone:833-336-6861
Mailing Address - Fax:
Practice Address - Street 1:1520 SOUTH BLVD STE 220
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-3717
Practice Address - Country:US
Practice Address - Phone:833-336-6861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5016385363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily