Provider Demographics
NPI:1750391082
Name:WISE, RONETTE (APN)
Entity type:Individual
Prefix:
First Name:RONETTE
Middle Name:
Last Name:WISE
Suffix:
Gender:
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MARKET PL
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-3555
Mailing Address - Country:US
Mailing Address - Phone:870-236-4001
Mailing Address - Fax:870-236-4009
Practice Address - Street 1:5 MARKET PL
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-3555
Practice Address - Country:US
Practice Address - Phone:870-236-4001
Practice Address - Fax:870-236-4009
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR33433163W00000X
ARA003308363LF0000X
ARS01116364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No163W00000XNursing Service ProvidersRegistered Nurse
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARA003308OtherARKANSAS STATE BOARD OF NURSING
ARP00897OtherRNP
ARR33433OtherRN LICENSE
ARP00897OtherRNP
1249413MWOtherDEA