Xaquita Wicks, FNP-C, MSN, BSN, RN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

1106498 Issued in TX

Practice address

2922B MLK Jr Blvd
Dallas, TX 75215-2321

Phone

(214) 708-2739

NPI assigned

Jun 9, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

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

Bachelor on Science - Nursing, Master of Science - Nursing, Nurse Practitioner, Registered Nurse

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: xaquita.wicks.1@17390.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.

• Martin Luther King Jr Family Clinic

  • Federally Qualified Health Center (FQHC)
  • Dallas, TX
  • NPI 1851492557
  Medicare reassignment
• Dallas County Mental Health & Mental Retardation Center

  • Psychiatry Physician
  • Dallas, TX
  • NPI 1023239886

  Multi-Specialty

  NPD (past)

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

{
    "created_epoch": "1496966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673481600000",
    "number": "1790214989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1759 BROAD PARK CIR S STE 113",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760637836",
            "telephone_number": "817-473-1312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2922B MLK JR BLVD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752152321",
            "telephone_number": "214-708-2739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKS",
        "first_name": "XAQUITA",
        "credential": "FNP-C, MSN, BSN, RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-06-09",
        "last_updated": "2023-01-12",
        "certification_date": "2023-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1106498",
            "primary": true
        },
        {
            "code": "163WG0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, General Practice",
            "state": "TX",
            "license": "847794",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NURSE LICENSE",
            "identifier": "847794",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jonathan Eric Wickiser, MD
• Lisa Baker Wicklund, LMFT-A
• Itala Manosha Wickremasinghe, MD
• Joyclyn T Wicks, M.D.
• Sarah Wicks, CAA
• Kristina Widjaja, PA-C
• Elizabeth Widtfeldt, LPC
• Robert Arthur Wiebe, MD
• Jaime Lauren Wiebel, MD
• Linda M Wiede, WHCNP

• Family Nurse Practitioner in Dallas, TX
• Providers in Dallas, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2023; 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.