Doctor Name: | JAMIE LYNN WISE |
NPI Number: | 1558603407 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP-BC |
License Number: | 17378 |
Business Practice Address: | 4772 Navy Rd Millington, TN - 380531927 |
Business Phone Number: | 9018734501 |
Business Fax Number: | |
Mailing Address: | 6831 Andrews Rd, BARTLETT |
State: | TN |
Postal Code: | 381353030 |
Phone Number: | 9014866834 |
Fax Number: | |
NPI Enumeration Date: | 03/19/2013 |
NPI Last Update Date: | 03/19/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 17378 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |