Betty R Wickstrom, N.P.

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

RN045532 Issued in GA

Practice address

960 Johnson Ferry Rd NE
Suite 336
Atlanta, GA 30342-1631

Phone

(404) 252-7400

Fax

(404) 252-1772

NPI assigned

Jul 8, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.441.396886
• Direct secure messaging: betty.wickstrom.1@10512.direct.athenahealth.com

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

• North Atlanta Kidney Specialists

  • Nephrology Physician
  • Atlanta, GA
  • NPI 1598872434
  Medicare reassignment NPD

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

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1669405197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "960 JOHNSON FERRY RD NE",
            "address_2": "SUITE 336",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421631",
            "telephone_number": "404-252-7400",
            "fax_number": "404-252-1772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "960 JOHNSON FERRY RD NE",
            "address_2": "SUITE 336",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421631",
            "telephone_number": "404-252-7400",
            "fax_number": "404-252-1772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKSTROM",
        "first_name": "BETTY",
        "middle_name": "R",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "GA",
            "license": "RN045532",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrew Craig Wickliffe, MD
• Charles W Wickliffe, MD
• Jayne Wickliffe
• Madison Marie Wickline
• Jaime Wicks, MD
• Lauren Widman, RN, NP-S
• Joshua Widner
• Lucas Wieck
• Christine Patricia Wiedenhoft
• Max Alan Wieder

• Adult Health Nurse Practitioner in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Adult Health Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.

Verify at the official NPI Registry.