Wicks, Dane K

Wicks, Dane K is an individual health care provider with primary practice located at 4251 Northern Ave Honor Annex Kansas City Va, Kansas City MO 64133. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Geriatric Medicine. Allopathic & Osteopathic Physicians / Family Medicine is her primary health care specialty. Wicks, Dane K can be contacted via phone (816) 922-2870.

Contact Information

Primary practice address
4251 Northern Ave Honor Annex Kansas City Va Kansas City MO 64133
Phone: (816) 922-2870
Fax: (816) 922-4823
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X R4C66 Missouri
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 84-288 New Mexico
Allopathic & Osteopathic Physicians / Geriatric Medicine 207QG0300X 84-288 New Mexico

Profile Details

NPI number 1912989138
LBN Legal business name Wicks, Dane K
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 15th, 2005
Last updated Oct 7th, 2016 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1912989138 NPPES
New Mexico MEDICAID 34025

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