MEDICARE: MICAYLA DAWN WISEMAN-FISHER PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	001014436	NC

General Provider Information

NPI Number	:	1437978988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICAYLA DAWN WISEMAN-FISHER PA-C

Provider Business Mailing Address
First Line	:	1700 TARBORO ST W STE 204
Second Line	:
City	:	WILSON
State	:	NC
Zip	:	27893-3481
Country	:	US
Telephone Number	:	252-399-5300
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 TARBORO ST W STE 204
Second Line	:
City	:	WILSON
State	:	NC
Zip	:	27893-3481
Country	:	US
Telephone Number	:	252-399-5300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2024
Last Update Date	:	01/08/2026

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