Most Relevant Information
Provider Data
| NPI Number: | 1003506114 |
| Provider Name: | KENNETH JAMES WICKEY PA |
| Entity Type: | Individual |
| Taxonomy Code: | 363A00000X |
| Specialty: | Physician Assistant |
| License Number: | 0010-13919 |
Most Important Dates
| Enumeration Date: | 05/11/2023 |
| Last Updated: | 08/20/2024 |
Provider Practice Location
3158 FREEDOM DR STE 3102
CHARLOTTE
NC
282080014
Practice Location Phone/Fax
| Phone: | 7043320396 |
| Fax: |
Provider Mailing Location
3158 FREEDOM DR STE 3101
CHARLOTTE
NC
282080014
Provider Mailing Phone/Fax
| Phone: | 7043482992 |
| Fax: |