Individual
AMY WICKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
100 W DEAN KEETON ST, AUSTIN, TX 78712-1091
(512) 471-4955
Mailing address
100 W DEAN KEETON ST, AUSTIN, TX 78712-1091
(512) 471-4955
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA04282
TX
363AM0700X
Medical Physician Assistant
Primary
PA04282
TX
Other
Enumeration date
05/23/2005
Last updated
02/16/2024
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