Active NPI
Jesse M Wickham, D.O.
- Nephrology Physician
- Jbsa Ft Sam Houston, TX
National Provider Identifier
1376602060
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nephrology Physician
- License
- 23573
- Practice address
- 3551 Roger Brooke Dr
Jbsa Ft Sam Houston, TX 78234-4504 - Phone
- (210) 916-7408
- Fax
- (210) 916-3585
- NPI assigned
- Dec 8, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician | 207RN0300X | 23573 | MS | Primary |
| Nephrology Physician | 207RN0300X | 02003331A | IN |
Addresses
Primary practice location
3551 Roger Brooke Dr
Jbsa Ft Sam Houston, TX 78234-4504
Mailing address
3551 Roger Brooke Dr
Jbsa Ft Sam Houston, TX 78234-4504
Phone (210) 916-7809
Other practice location 1
301 Fisher St
Keesler Medical Center, 81MDOS/SGOMK, Nephrology
Keesler AFB, MS 39534-2508
Phone (228) 376-5537
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250923003563 | MS | Order and Referring Only - Nephrology | 0244530301 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 02003331A | IN | MD | Nephrology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165536000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1781740800000",
"number": "1376602060",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3551 ROGER BROOKE DR",
"city": "JBSA FT SAM HOUSTON",
"state": "TX",
"postal_code": "782344504",
"telephone_number": "210-916-7809",
"fax_number": "210-916-3585"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3551 ROGER BROOKE DR",
"city": "JBSA FT SAM HOUSTON",
"state": "TX",
"postal_code": "782344504",
"telephone_number": "210-916-7408",
"fax_number": "210-916-3585"
}
],
"practiceLocations": [
{
"address_1": "301 Fisher St",
"address_2": "Keesler Medical Center, 81MDOS/SGOMK, Nephrology",
"address_purpose": "LOCATION",
"city": "Keesler AFB",
"state": "MS",
"postal_code": "395342508",
"country_code": "US",
"telephone_number": "228-376-5537",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WICKHAM",
"first_name": "JESSE",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-08",
"last_updated": "2026-06-18",
"certification_date": "2026-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "207RN0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Nephrology",
"state": "MS",
"license": "23573",
"primary": true
},
{
"code": "207RN0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Nephrology",
"state": "IN",
"license": "02003331A",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jbsa Ft Sam Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.