KELLY WICKSTROM D.O. NPI 1083092589

NPI Information

Kelly Wickstrom, D.O. is a critical care medicine internal medicine in Tucson, AZ. The provider is an internist who diagnoses, treats and supports patients with multiple organ dysfunction. This specialist may have administrative responsibilities for intensive care units and may also facilitate and coordinate patient care among the primary physician, the critical care staff and other specialists. Kelly Wickstrom, D.O. NPI is 1083092589. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

5301 E GRANT RD
TUCSON, AZ
ZIP 85712-805
Phone: (520) 324-5696
Fax: (520) 324-1583

The NPI 1083092589 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 5/15/2015 and was last updated on 4/29/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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