Amanda Patterson Wickson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA02797 Issued in TX

Practice address

808 Keller Pkwy
Keller, TX 76248-2405

Phone

(817) 431-2573

Fax

(817) 379-6881

NPI assigned

Jul 30, 2007

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 TX

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

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: amanda.wickson.1@28296.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.

• Keller Family Medical Center, PLLC

  • Family Medicine Physician
  • Keller, TX
  • NPI 1407489347
  Medicare reassignment

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

{
    "created_epoch": "1185753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1287100800000",
    "number": "1710177464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "808 KELLER PKWY",
            "city": "KELLER",
            "state": "TX",
            "postal_code": "762482405",
            "telephone_number": "817-431-2573",
            "fax_number": "817-379-6881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "808 KELLER PKWY",
            "city": "KELLER",
            "state": "TX",
            "postal_code": "762482405",
            "telephone_number": "817-431-2573",
            "fax_number": "817-379-6881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKSON",
        "first_name": "AMANDA",
        "middle_name": "PATTERSON",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-30",
        "last_updated": "2010-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA02797",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anna G White, M.D.
• Christina Leigh White
• Michael A White, MD
• Noah Lyons Whited
• Kristina Whitley
• Kendrick Widemon
• William Musgrave MHT LLC
• Judy (Carolyn) Williams, LPC
• Lori Williams
• Mackenzie Williams

• Physician Assistant in Keller, TX
• Providers in Keller, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2010; 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.