DR. JESSE M WICKHAM (NPI# 1376602060) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376602060 |
| Entity Type | Individual |
| Full Name | DR. JESSE M WICKHAM |
| Credential | D.O. |
| Practice Address |
3551 Roger Brooke Dr Jbsa Ft Sam Houston TX 78234-4504 |
| Practice Telephone | 2109167408 |
| Practice Fax Number | 2109163585 |
| Mailing Telephone | 2109167408 |
| Mailing Fax Number | 2109163585 |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2018-03-17 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RN0300X |
Internal Medicine Specialization: Nephrology |
23573 | MS | Allopathic & Osteopathic Physicians |
| N | 207RN0300X |
Internal Medicine Specialization: Nephrology |
02003331A | IN | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 301 Fisher St, Keesler Medical Center, 81mdos/sgomk, Nephrology, Keesler Afb, MS 395342508 | 2283765537 |
| Street Address |
3551 ROGER BROOKE DR |
| City | JBSA FT SAM HOUSTON |
| State | TX |
| Zip Code | 78234-4504 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023616398 | Emily M Covais | Student in an Organized Health Care Education/Training Program | 3551 Roger Brooke Dr, Jbsa Ft Sam Houston, TX 78234-4504 | 2020-10-09 |
| 1730793191 | George Brett Pulvermacher | Physical Therapist | 3551 Roger Brooke Dr, Jbsa Ft Sam Houston, TX 78234-4504 | 2020-09-03 |
| 1053922559 | Aline Noelle Ulloa | Student in an Organized Health Care Education/Training Program | 3551 Roger Brooke Dr, Jbsa Ft Sam Houston, TX 78234-4504 | 2020-08-10 |
| 1538778931 | Caroline Elizabeth Conner | Pharmacist | 3551 Roger Brooke Dr, Jbsa Ft Sam Houston, TX 78234-4504 | 2020-07-31 |
| 1487263406 | Mary Michelle Ayres | Nurse Practitioner | 3551 Roger Brooke Dr, Jbsa Ft Sam Houston, TX 78234-4504 | 2020-07-27 |
| 1265040612 | Suzanne Elise Laux | Nurse Practitioner | 3551 Roger Brooke Dr, Jbsa Ft Sam Houston, TX 78234-4504 | 2020-07-21 |
| 1801414677 | James Martin Maloney | Student in an Organized Health Care Education/Training Program | 3551 Roger Brooke Dr, Jbsa Ft Sam Houston, TX 78234-4504 | 2020-07-08 |
| 1861019473 | Jonathan Lee Custer | Nurse Anesthetist, Certified Registered | 3551 Roger Brooke Dr, Jbsa Ft Sam Houston, TX 78234-4504 | 2020-06-30 |
| 1528685336 | Erin Wheeler | Physical Therapist | 3551 Roger Brooke Dr, Jbsa Ft Sam Houston, TX 78234-4504 | 2020-06-26 |
| 1821614322 | Ryan Hyatt | Student in an Organized Health Care Education/Training Program | 3551 Roger Brooke Dr, Jbsa Ft Sam Houston, TX 78234-4504 | 2020-06-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255942884 | Thomas Ballas | Student in an Organized Health Care Education/Training Program | 3551 Roger Brooke Drive Jbsa-fort Sam Houston, Department of Behavioral Medicine-mche-dbm, San Antonio, TX 78234 | 2020-08-17 |
| 1124657366 | Wendy Harris | Pharmacist | 3041 Garden Ave, Fort Sam Houston, TX 78234 | 2020-04-08 |
| 1215564729 | Travis Frantz | Student in an Organized Health Care Education/Training Program | 3551 Rodger Brooke Drive, Jbsa Fort Sam Houston, TX 78234 | 2020-03-25 |
| 1508492695 | Matthew Grossmann | Student in an Organized Health Care Education/Training Program | San Antonio Military Medical Center, Mche-zdm-m, Internal Medicine Residency, 3551 Roger Brooke Dr., Jbsa-fort Sam Houston, TX 78234 | 2020-03-20 |
| 1235793407 | Jessica Maria May Franklin | Student in an Organized Health Care Education/Training Program | 3551 Roger Brooke Drive Jbsa Fort Sam Houston, San Antonio, TX 78234 | 2019-04-23 |
| 1730663477 | Glen Snyder | Military Health Care Provider | 3488 Garden Ave Anderson Hall, Fort Sam Houston, San Antonio, TX 78234 | 2018-09-19 |
| 1265919336 | Ashley Elizabeth Malawey | Military Health Care Provider | 3222 Cpl Johnson Road, San Antonio, TX 78234 | 2018-07-23 |
| 1053805515 | Rene Espinosa | Social Worker | San Antonio Medical Center, 3551 Roger Brooke Dr, Jbsa, TX 78234 | 2018-06-19 |
| 1235622333 | Melanie Edith Rivera | Military Health Care Provider | 3600 Roger Brooke Drive, San Antonio, TX 78234 | 2018-06-13 |
| 1063909158 | Benjamin Walker Appelo | General Practice | San Antonio Mil Med Center 3551 Roger Brooke Dr, Mche-zdm-m, San Antonio, TX 78234 | 2018-04-16 |
| Find all providers in zip 78234 | ||||
| Taxonomy Code | 207RN0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Nephrology |
| An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
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| 1578106894 | Cardiorenal Therapeutics of North Texas Pllc | Internal Medicine | 300 N Highland Ave Ste 365, Sherman, TX 75092-7393 | 2019-10-18 |
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| 1376193433 | Ntkc - Dfw, Pllc | Internal Medicine | 10700 Victoria Ash Dr., Keller, TX 76244 | 2019-09-19 |
| 1841849098 | Austin Kidney Care LLC | Internal Medicine | 2005 Palo Duro Rd, Austin, TX 78757-3242 | 2019-09-10 |
| 1467000828 | Ntkc-dfw, Pllc | Internal Medicine | 2220 Bryan Pl Ste 104, Midlothian, TX 76065-7127 | 2019-08-29 |
| 1306407697 | H&n Medical Investment, LLC | Internal Medicine | 4201 Medical Center Dr. Ste 240, Mckinney, TX 75069-1774 | 2019-06-26 |
| Find all providers with the same taxonomy | ||||
| City | JBSA FT SAM HOUSTON |
| Zip Code | 78234 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.