Active NPI
Debra Wickliffe
- Contractor
- Lake City, FL
National Provider Identifier
1821285446
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- 6908802996
- Practice address
- 134 NW Olive GLN
Lake City, FL 32055-9210 - Phone
- (386) 965-2770
- Fax
- (386) 754-2770
- NPI assigned
- Sep 27, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 6908802996 | FL | Primary |
Addresses
Primary practice location
134 NW Olive GLN
Lake City, FL 32055-9210
Mailing address
134 NW Olive GLN
Lake City, FL 32055-9210
Phone (386) 965-2770
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6908802965 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6908802996 | FL | MD | Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190851200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1190851200000",
"number": "1821285446",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "134 NW OLIVE GLN",
"city": "LAKE CITY",
"state": "FL",
"postal_code": "320559210",
"telephone_number": "386-965-2770",
"fax_number": "386-965-2770"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "134 NW OLIVE GLN",
"city": "LAKE CITY",
"state": "FL",
"postal_code": "320559210",
"telephone_number": "386-965-2770",
"fax_number": "386-754-2770"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WICKLIFFE",
"first_name": "DEBRA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-09-27",
"last_updated": "2007-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "FL",
"license": "6908802996",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6908802965",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake City, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.