Chaeli Wisenbaker, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

2412 N Oak St
Valdosta, GA 31602-2567

Phone

(229) 244-1400

Fax

(229) 244-5512

NPI assigned

Jun 3, 2014

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Chaeli Nelson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1401753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1463702400000",
    "number": "1003229568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3832 DANE LN",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "31601",
            "telephone_number": "229-740-3604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2412 N OAK ST",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316022567",
            "telephone_number": "229-244-1400",
            "fax_number": "229-244-5512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISENBAKER",
        "first_name": "CHAELI",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-06-03",
        "last_updated": "2016-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEORGIA LICENSE",
            "identifier": "7207",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHAELI",
            "last_name": "NELSON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Winnersville Long Term Care Packaging
• Winnersville Pharmacy LLC
• Winnersville Pharmacy, LLC
• July Wise
• Marcie C Wiseman, PHD
• Regina Katherine Wisenbaker, LCSW
• Patricia M Wittenborn, LCSW
• Anna Wolford, PP
• Robertus Wolters, RPT
• Kathryn Marie Woltz, PA-C

• Medical Physician Assistant in Valdosta, GA
• Providers in Valdosta, GA by specialty
• Medical Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.