Provider Demographics
NPI:1336768993
Name:WISE, CARLA M (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:M
Last Name:WISE
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5440 HIGHWAY 136 W
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-9611
Mailing Address - Country:US
Mailing Address - Phone:270-869-4151
Mailing Address - Fax:
Practice Address - Street 1:1200 PROFESSIONAL BLVD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-8002
Practice Address - Country:US
Practice Address - Phone:812-479-9500
Practice Address - Fax:812-437-0037
Is Sole Proprietor?:No
Enumeration Date:2020-04-14
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3014414363L00000X
IN71012646A363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner