Individual
MACY LICKTEIG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
310 S HILLSIDE ST, WICHITA, KS 67211-2129
(316) 264-3505
Mailing address
310 S HILLSIDE ST, WICHITA, KS 67211-2129
(316) 265-3505
(316) 264-0908
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
KS
Other
Enumeration date
05/28/2024
Last updated
03/17/2026
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