Malissa R Wightman, RN, APNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

1069 Issued in WI

Practice address

2825 Prairie Ave
Beloit, WI 53511-1844

Phone

(608) 363-5500

NPI assigned

Apr 25, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner, Registered Nurse

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mercy Health System Corporation

  • Durable Medical Equipment & Medical Supplies
  • Beloit, WI
  • NPI 1619000437
  NPD (past)
• Mercy Health System Corporation

  • Critical Access Hospital
  • Lake Geneva, WI
  • NPI 1699728550
  NPD (past)

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

{
    "created_epoch": "1177459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1063631083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2825 PRAIRIE AVE",
            "city": "BELOIT",
            "state": "WI",
            "postal_code": "535111844",
            "telephone_number": "608-363-5500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2825 PRAIRIE AVE",
            "city": "BELOIT",
            "state": "WI",
            "postal_code": "535111844",
            "telephone_number": "608-363-5500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIGHTMAN",
        "first_name": "MALISSA",
        "middle_name": "R",
        "credential": "RN, APNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "WI",
            "license": "1069",
            "primary": true
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "WI",
            "license": "113626",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43880300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rebecca Lynn White, PT
• Renee White, RN
• Mary Whitney-Hartje
• Anny Wicyk, APNP
• Andrew Michael Wiegel, PHARMD
• Wild World Counseling and Coaching,LLC
• Cynthia J Williams
• Kassandra Elizabeth Wilson
• Nancy J. Wilson, M.D.
• Shawn P Wilson, MD

• Pediatric Nurse Practitioner in Beloit, WI
• Providers in Beloit, WI by specialty
• Pediatric Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.