Provider Demographics
NPI:1992476485
Name:WICE, KAYLE ANNE (NP-C)
Entity type:Individual
Prefix:
First Name:KAYLE
Middle Name:ANNE
Last Name:WICE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1796 STATE ROUTE 8
Mailing Address - Street 2:
Mailing Address - City:OIL CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16301-6140
Mailing Address - Country:US
Mailing Address - Phone:814-758-4701
Mailing Address - Fax:
Practice Address - Street 1:6885 US 322 STE 3
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:PA
Practice Address - Zip Code:16323-8000
Practice Address - Country:US
Practice Address - Phone:814-678-4810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP024421363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner