Individual
DANE K WICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
400 SW LONGVIEW BLVD STE 280, LEES SUMMIT, MO 64081-2157
(337) 991-9276
Mailing address
5750 JOHNSTON ST STE 205, LAFAYETTE, LA 70503-5345
(337) 991-9276
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
84-288
NM
207Q00000X
Family Medicine Physician
Primary
R4C66
MO
207QG0300X
Geriatric Medicine (Family Medicine) Physician
84-288
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34025
—
NM
Enumeration date
11/15/2005
Last updated
04/24/2026
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