Thomas Robert Wikstrom, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

ME0052161 Issued in FL

Practice address

6817 Southpoint Pkwy
Suite 2503
Jacksonville, FL 32216-6282

Phone

(904) 396-0425

Fax

(904) 396-0448

NPI assigned

Jun 18, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Thomas R. Wikstrom, MD, PA

  • Psychiatry Physician
  • Jacksonville, FL
  • NPI 1356635239
  Authorized official Same address or phone

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

{
    "created_epoch": "1150588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482364800000",
    "number": "1952346553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6817 SOUTHPOINT PKWY",
            "address_2": "SUITE 2503",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322166282",
            "telephone_number": "904-396-0425",
            "fax_number": "904-396-0448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6817 SOUTHPOINT PKWY",
            "address_2": "SUITE 2503",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322166282",
            "telephone_number": "904-396-0425",
            "fax_number": "904-396-0448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIKSTROM",
        "first_name": "THOMAS",
        "middle_name": "ROBERT",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-18",
        "last_updated": "2016-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "ME0052161",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1952346553",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Onisha Renee Wiggins, APRN
• Pamela Wiggins, ED.D.
• Megan Elizabeth Wiggs, OTD
• Mary Wihnyk, LMHC
• Karn Wijarnpreecha, M.D., MPH
• Jeremy S. Wilbanks, PA-C
• Nishauna E Wilbert, LCSW
• Ashley Wilborn
• Catherine Cabell Wilbraham, MPT
• Bruce Anthony Wilburn, CRNA

• Psychiatry Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Psychiatry Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.