Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Emily Louise Wickersham, DO

Individual provider Anatomic Pathology & Clinical Pathology Physician · NPI 1093175358

Emily Louise Wickersham, DO is a Pathology in Bolivar, Missouri. Qualified in 2020, 6 years ago. Practices with Citizens Memorial Hospital District, a 48-clinician group and accepts Medicare assignment. Licensed in Illinois and Missouri.

Years since qualifying
6
Licensed in
IL, MO
In the registry since
2016
Specialties on file
2
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

See every abbreviation used in this directory →

Practice location Address checks out

1500 N Oakland Ave
Bolivar, MO 65613-3099
Phone: (417) 326-6000
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Anatomic Pathology & Clinical Pathology Physician (primary) Taxonomy 207ZP0102X · Licence 2024028249 (MO)
Anatomic Pathology & Clinical Pathology Physician Taxonomy 207ZP0102X · Licence 036.177695 (IL)

Record details

NPI number1093175358
Entity typeIndividual (Type 1)
GenderFemale
Credentials DO
Sole proprietorNo
NPI enumeratedFebruary 29, 2016
Last updated in NPPESJanuary 15, 2026
Certification dateJanuary 15, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPATHOLOGY
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Citizens Memorial Hospital District — 48 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare