Individual
MS. ANGELA K WICKSTRUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4115 E LANCASTER AVE, FORT WORTH, TX 76103-3614
(817) 369-8526
(817) 764-0714
Mailing address
PO BOX 746079, ATLANTA, GA 30374-6079
(773) 352-1515
(312) 929-0373
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA04934
TX
Other
Enumeration date
07/23/2009
Last updated
09/18/2025
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