Provider Demographics
NPI:1689637340
Name:WISEMAN, MICHAEL B (FNP)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:B
Last Name:WISEMAN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1450 DOWELL SPRINGS BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909
Mailing Address - Country:US
Mailing Address - Phone:865-637-8812
Mailing Address - Fax:865-637-8865
Practice Address - Street 1:800 OAK RIDGE TURNPIKE
Practice Address - Street 2:SUITE A-402
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830
Practice Address - Country:US
Practice Address - Phone:865-637-8812
Practice Address - Fax:865-824-4886
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2021-05-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC201214363LF0000X
TN16227363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1529982Medicaid