MS. ANGELA K WICKSTRUM (NPI# 1912137977) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912137977 |
| Entity Type | Individual |
| Full Name | MS. ANGELA K WICKSTRUM |
| Credential | PA-C |
| Practice Address |
5301 William D Tate Ave Grapevine TX 76051-7357 |
| Mailing Address |
Po Box 9101 Coppell TX 75019-9494 |
| Practice Telephone | 8172512101 |
| Mailing Telephone | 9727457500 |
| Mailing Fax Number | 9727454336 |
| Enumeration Date | 2009-07-23 |
| Last Update Date | 2015-01-12 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA04934 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
5301 WILLIAM D TATE AVE |
| City | GRAPEVINE |
| State | TX |
| Zip Code | 76051-7357 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104803923 | Lee W Haak | Family Medicine | 5301 William D Tate Ave, Grapevine, TX 76051-7357 | 2005-12-22 |
| 1588900187 | Vista Rehab Partners, Lp | Physical Therapist | 5301 William D Tate Ave, Grapevine, TX 76051-7357 | 2012-12-31 |
| 1770870198 | Roberto Gutierrez | Physical Therapy Assistant | 5301 William D Tate Ave, Grapevine, TX 76051-7357 | 2011-07-06 |
| 1134410848 | Sherri L Powell | Physician Assistant | 5301 William D Tate Ave, Grapevine, TX 76051-7357 | 2011-04-28 |
| 1831268911 | Mary Steffens | Family Medicine | 5301 William D Tate Ave, Grapevine, TX 76051-7357 | 2006-11-06 |
| 1356410435 | Tony Keeble | Family Medicine | 5301 William D Tate Ave, Grapevine, TX 76051-7357 | 2006-11-06 |
| 1831131127 | Amy Louise Depue | Family Medicine | 5301 William D Tate Ave, Grapevine, TX 76051-7357 | 2006-06-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881227346 | Jeffrey Joseph Cervenka | Physical Therapist | 2421 Ira E Woods Ave #101, Grapevine, TX 76051 | 2020-02-12 |
| 1871137562 | Karen Lorince | Counselor | 2409 N. Support Road, Grapevine, TX 76051 | 2019-11-05 |
| 1548733785 | Jessica Thorman Johnson | Dietitian, Registered | 1056 Texan Trail (fortis Bmi), Grapevine, TX 76051 | 2019-01-10 |
| 1164928958 | Kristen Diou | Counselor | 913 S Church St Ste 103, Grapevine, TX 76051 | 2018-04-02 |
| 1356860597 | Anissa Singratanakul D.m.d, Pllc | Dentist | 1231 William D Tate Suite 400, Grapevine, TX 76051 | 2017-09-19 |
| 1033637665 | James Abraham Thomas | Pharmacy | 1601 W. State Hwy 114, Grapevine, TX 76051 | 2017-09-04 |
| 1437606563 | D'anna Sims | Counselor | 2451 Stone Myers Parkway, #100, Grapevine, TX 76051 | 2016-09-07 |
| 1477006369 | Melinda Jeanne Mashburn | Nurse Practitioner | 1600 West College St., Suite 60, Grapevine, TX 76051 | 2016-07-27 |
| 1437506623 | Allcare Physicians Group | Registered Nurse | 1111 S Main St Ste 119, Grapevine, TX 76051 | 2016-05-18 |
| 1790141745 | Colwick Counseling | Clinic/Center | 1400 W. Northwest Highway Suite 260, Grapevine, TX 76051 | 2016-01-06 |
| Find all providers in zip 76051 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730718321 | Cameron Taylor Smith | Physician Assistant | 951 Turner Rd Apt 1018, Grapevine, TX 76051-7219 | 2020-04-06 |
| 1174022248 | Maxine Zarbinian | Physician Assistant | 1900 Enchanted Way Ste 100, Grapevine, TX 76051-1022 | 2018-02-05 |
| 1225546328 | Jessica Ann Jensen | Physician Assistant | 5301 William D Tate Ave Unit 100, Grapevine, TX 76051-7357 | 2018-01-11 |
| 1225545940 | Dara Elizabeth Comer | Physician Assistant | 1120 S Main St # 100, Grapevine, TX 76051-5543 | 2018-01-03 |
| 1912414624 | Marissa Blaire Spencer | Physician Assistant | 1600 W Northwest Hwy Ste 100, Grapevine, TX 76051-8131 | 2018-01-03 |
| 1770844698 | Craig E Zahn | Physician Assistant | 3601 Grapevine Mills Pkwy, Grapevine, TX 76051-1975 | 2012-06-07 |
| 1831493659 | Joanna I. Yamoah | Physician Assistant | 2020 W State Highway 114 Ste 110, Grapevine, TX 76051-8648 | 2011-01-09 |
| 1124330816 | Alicia Marie Stem | Physician Assistant | 2020 W State Highway 114 Ste 200, Grapevine, TX 76051-8648 | 2010-07-09 |
| 1104919190 | Tamisha Renee Piper | Physician Assistant | 3801 William D Tate Ave Ste 840-a, Grapevine, TX 76051-8755 | 2006-10-02 |
| 1407831100 | Andrea Wise Rodriguez | Physician Assistant | 1600 W Northwest Hwy, Ste 900, Grapevine, TX 76051-8112 | 2005-12-14 |
| Find all providers in GRAPEVINE | ||||
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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.