Individual
KRISTIN WICKHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
200 CLINIC DR, MADISONVILLE, KY 42431-1661
(270) 825-7200
Mailing address
2700 STANLEY GAULT PARKWAY STE 129, LOUISVILLE, KY 40225-5176
(502) 253-4900
(502) 489-5751
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
11018785A
IN
207Q00000X
Family Medicine Physician
Primary
52925
KY
Other
Enumeration date
06/22/2016
Last updated
10/15/2019
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