Healthcare Provider Details

I. General information

NPI: 1093609638
Provider Name (Legal Business Name): KAROLINA WISE AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2025
Last Update Date: 06/06/2025
Certification Date: 05/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 WESTERN BLVD
JACKSONVILLE NC
28546-6379
US

IV. Provider business mailing address

300 BRIBSTER CT S
JACKSONVILLE NC
28540-4356
US

V. Phone/Fax

Practice location:
  • Phone: 910-577-2345
  • Fax:
Mailing address:
  • Phone: 682-556-1865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number5022319
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: