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NPI Code Detail

MEDICARE: CYMONE WISEMON

MEDICARE: CYMONE WISEMON
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
1106S00000XBehavior Technician41180963TX

General Provider Information

NPI Number : 1356874705
Entity Type Code : Individual
Provider Name (Legal Business Name) : CYMONE WISEMON
Provider Business Mailing Address
First Line : 5200 STAR DR APT 1617
Second Line :
City : FORT WORTH
State : TX
Zip : 76132-3321
Country : US
Telephone Number : 501-944-9863
Fax Number :
Provider Business Practice Location Address
First Line : 5200 STAR DR APT 1617
Second Line :
City : FORT WORTH
State : TX
Zip : 76132-3321
Country : US
Telephone Number : 501-944-9863
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2017
Last Update Date : 04/04/2017

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Directions to “ CYMONE WISEMON ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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