Individual
KYLE ALLEN WICKLIFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3850 W WEYBURN RD, RICHMOND, VA 23235-2044
(540) 729-7407
Mailing address
3850 W WEYBURN RD, RICHMOND, VA 23235-2044
(540) 729-7407
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
0001263425
VA
367500000X
Certified Registered Nurse Anesthetist
Primary
0024186283
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001263425
RN LICENSE
VA
Enumeration date
03/06/2022
Last updated
03/14/2025
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