Provider Demographics
NPI:1215362116
Name:WISNER, AUDREY MESKILL (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:MESKILL
Last Name:WISNER
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:
Other - Last Name:MESKILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:401 KEISLER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-7084
Mailing Address - Country:US
Mailing Address - Phone:919-439-6120
Mailing Address - Fax:919-246-4420
Practice Address - Street 1:6224 FAYETTEVILLE RD STE 105
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6288
Practice Address - Country:US
Practice Address - Phone:919-439-6120
Practice Address - Fax:919-246-4420
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC126250163WP0808X
NC5006472363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health