NPIMap

Individual provider Active NPI

Kenneth James Wickey, PA

  • Physician Assistant
  • Charlotte, NC
National Provider Identifier
1003506114
Registry record updated Mar 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-13919 Issued in NC
Practice address
3158 Freedom Dr Ste 3102
Charlotte, NC 28208-0014
Phone
(704) 332-0396
NPI assigned
May 11, 2023
Last updated
Mar 27, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-13919 NC Primary

Addresses

Primary practice location

3158 Freedom Dr Ste 3102
Charlotte, NC 28208-0014

Mailing address

3158 Freedom Dr Ste 3101
Charlotte, NC 28208-0014
Phone (704) 348-2992

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kwickey66489@direct.acumenmd.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240306001018 NC Practitioner - Physician Assistant 5092151621 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Metrolina Nephrology Associates PAGroup PAC ID 8022916600, 85 clinicians

Practice addresses (Care Compare)

1640 Campus Park Dr C
Monroe, NC 28112-5284
Phone (704) 226-0366

2544 Court Dr
F
Gastonia, NC 28054-3450
Phone (704) 864-8302

3158 Freedom Dr
Charlotte, NC 28208-0014
Phone (704) 348-2992

3310 Perry St
Concord, NC 28027-3901
Phone (704) 786-7770

9800 Kincey Ave
Suite 150
Huntersville, NC 28078-8405
Phone (704) 766-1630

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0010-13919NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Carolinas Medical Center CurrentSince Apr 7, 2024 Accepting new patients
Carolinas Medical Center CurrentSince Apr 7, 2024 Accepting new patients

Locations

1000 Blythe Blvd
Charlotte, NC 28203
Phone (704) 351-3791

Interoperability endpoints

  • FHIR API: https://epicproxy.et1041.epichosted.com/FHIRProxy/api/FHIR/R4
  • Direct secure messaging: kwickey1092638@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1683763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743033600000",
    "number": "1003506114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3158 FREEDOM DR STE 3101",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282080014",
            "telephone_number": "704-348-2992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3158 FREEDOM DR STE 3102",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282080014",
            "telephone_number": "704-332-0396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKEY",
        "first_name": "KENNETH",
        "middle_name": "JAMES",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-05-11",
        "last_updated": "2025-03-27",
        "certification_date": "2025-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-13919",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kwickey66489@direct.acumenmd.com",
            "affiliation": "N",
            "endpointDescription": "Acumen Direct Messaging",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CED",
            "address_1": "3158 Freedom Dr Ste 3101",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282080014",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.