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General NPI Number Information
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NPI Number | 1124646237
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Entity Type | Individual
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Provider Name | JOANNA WISEMAN APRN, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/07/2020
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 8601 SIX FORKS RD STE 400
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City | RALEIGH
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State | NC
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Zip | 27615-2965
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Country | US
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Telephone | 646-453-6777
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Fax | 904-390-7398
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Provider Business Mailing Address
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Address Line | 142 NIMS SPRING DR
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City | FORT MILL
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State | SC
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Zip | 29715-6461
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Country | US
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Telephone | 631-512-9807
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5017694
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN11022388
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 5017694
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 26568
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License Number State | SC
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