Individual
BREANNA WICKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1410 SW TRADITION DR STE 260, ANKENY, IA 50023-9188
(515) 875-9290
(515) 875-9291
Mailing address
PO BOX 424, DES MOINES, IA 50302-0424
(515) 875-9255
(515) 875-9223
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
094923
IA
Other
Enumeration date
12/07/2018
Last updated
10/15/2024
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