Provider Demographics
NPI:1932080959
Name:FICK, KERRY (CNS)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:FICK
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 MARYGLADE DR
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WI
Mailing Address - Zip Code:53024-1214
Mailing Address - Country:US
Mailing Address - Phone:414-219-6070
Mailing Address - Fax:
Practice Address - Street 1:1419 MARYGLADE DR
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WI
Practice Address - Zip Code:53024-1214
Practice Address - Country:US
Practice Address - Phone:414-219-6070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI562364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist