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NPI Code Detail

MEDICARE: MR. DUSTIN TAYLOR WISEMAN

MEDICARE: MR. DUSTIN TAYLOR WISEMAN
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
1101YP1600XPastoral Counselor

General Provider Information

NPI Number : 1205793775
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DUSTIN TAYLOR WISEMAN
Provider Business Mailing Address
First Line : 806 CLOVER LN
Second Line :
City : MANCHESTER
State : TN
Zip : 37355-2377
Country : US
Telephone Number : 931-723-0380
Fax Number : 931-723-0358
Provider Business Practice Location Address
First Line : 806 CLOVER LN
Second Line :
City : MANCHESTER
State : TN
Zip : 37355-2377
Country : US
Telephone Number : 931-723-0380
Fax Number : 931-723-0358
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/07/2026
Last Update Date : 01/07/2026

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