Individual
TRACY WICKERSHAM-FREY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
501 S BURMA AVE, GILLETTE, WY 82716-3426
(307) 688-1000
Mailing address
1121 WASHINGTON BLVD, NEWCASTLE, WY 82701-2968
(307) 746-3582
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA618
PA LICENSE
WY
Enumeration date
10/04/2014
Last updated
12/27/2023
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