Angela K Wickstrum, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA04934 Issued in TX

Practice address

4115 E Lancaster Ave
Fort Worth, TX 76103-3614

Phone

(817) 369-8526

Fax

(817) 764-0714

NPI assigned

Jul 23, 2009

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

Specialty

Physician Assistant

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Oak Street Health of Texas PLLCGroup PAC ID 2163843038, 103 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Oak Street Health of Texas, PLLC

  • Primary Care Clinic/Center
  • Fort Worth, TX
  • NPI 1497387419
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1248307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758153600000",
    "number": "1912137977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746079",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746079",
            "telephone_number": "773-352-1515",
            "fax_number": "312-929-0373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4115 E LANCASTER AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761033614",
            "telephone_number": "817-369-8526",
            "fax_number": "817-764-0714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKSTRUM",
        "first_name": "ANGELA",
        "middle_name": "K",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-23",
        "last_updated": "2025-09-18",
        "certification_date": "2025-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA04934",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maximillian Whooley, MD
• Amanda Kay Whorton, RT (R)(CT)
• Katherine Wickersham
• Clarissa Wicklund, LMFT
• Kari Wicklund, PA-C
• Josef Widerhorn, M.D.
• Elizabeth Suzanne Widmer, P.A.-C
• Lisa Widmer, OTR
• April Rose Wiechmann, PHD
• Kasi Elaine Wielenga

• Physician Assistant in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.