Active NPI
Kenzie Lane Wickman, PHARMD
- Pharmacist
- Madison, WI
National Provider Identifier
1891071585
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 13785-40
- Practice address
- 5702 Raymond Rd
Madison, WI 53711-4232 - Phone
- (608) 278-8037
- Fax
- (608) 278-8213
- NPI assigned
- Oct 26, 2011
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 13785-40 | WI | Primary |
Addresses
Primary practice location
5702 Raymond Rd
Madison, WI 53711-4232
Mailing address
5702 Raymond Rd
Madison, WI 53711-4232
Phone (608) 278-8037
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13785-40 | WI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1319587200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1319587200000",
"number": "1891071585",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5702 RAYMOND RD",
"city": "MADISON",
"state": "WI",
"postal_code": "537114232",
"telephone_number": "608-278-8037",
"fax_number": "608-278-8213"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5702 RAYMOND RD",
"city": "MADISON",
"state": "WI",
"postal_code": "537114232",
"telephone_number": "608-278-8037",
"fax_number": "608-278-8213"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WICKMAN",
"first_name": "KENZIE",
"middle_name": "LANE",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-10-26",
"last_updated": "2011-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "13785-40",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Madison, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.