Wickshire Port St. Lucie

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

WICKSHIRE PORT ST. LUCIE

Practice address

9825 S US Highway 1
Port St Lucie, FL 34952-5626

Phone

(772) 337-0084

NPI assigned

Oct 13, 2020

Organization subpart

No

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

Authorized official

Name

Dan O'Keefe

Title

Ceo

Phone

(615) 942-0240

Specialties & licenses 2

Addresses

Other names 1

• Wickshire Port St Lucie Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1602547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602547200000",
    "number": "1184222002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 OLD HICKORY BLVD",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370274528",
            "telephone_number": "615-942-0240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9825 S US HIGHWAY 1",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349525626",
            "telephone_number": "772-337-0084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WICKSHIRE PORT ST. LUCIE",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-13",
        "last_updated": "2020-10-13",
        "certification_date": "2020-10-13",
        "status": "A",
        "authorized_official_last_name": "O'KEEFE",
        "authorized_official_first_name": "DAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "615-942-0240"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wickshire Port St Lucie",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jessica White, OTR
• Kenneth Ray White, PH.D.
• Laurel Ann White
• Shane Donald Whiteley, DC
• Wholistic Medicine Clin
• Dennis Darnell Wideman II
• Alex Wilburn, LPTA
• Brandon Matthew Wildermuth, PHARMD
• Stacey Wilfork, RN
• Taylor Wilhelm, DPT

• Assisted Living Facility in Port St Lucie, FL
• Providers in Port St Lucie, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.