Individual
DR. KENNETH D. WICKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2018 W CLINCH AVE, KNOXVILLE, TN 37916-2301
(865) 541-8000
(865) 539-8008
Mailing address
PO BOX 634706, CINCINNATI, OH 45263-0001
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
MD18702
TN
208000000X
Pediatrics Physician
MD18702
TN
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
MD18702
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3055615
BLUE CROSS
TN
05
—
3082430
—
TN
05
—
3082433
—
TN
05
—
3082434
—
TN
01
—
3112589
BLUE CROSS
TN
01
—
4152062
BLUE CROSS
TN
05
—
64928021
—
KY
Enumeration date
06/26/2006
Last updated
11/21/2007
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