Healthcare Provider Details

I. General information

NPI: 1750391082
Provider Name (Legal Business Name): RONETTE WISE APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MARKET PL
PARAGOULD AR
72450-3555
US

IV. Provider business mailing address

5 MARKET PL
PARAGOULD AR
72450-3555
US

V. Phone/Fax

Practice location:
  • Phone: 870-236-4001
  • Fax: 870-236-4009
Mailing address:
  • Phone: 870-236-4001
  • Fax: 870-236-4009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR33433
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA003308
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: