Joanna Elise Wiese

Primary specialty

Prescribing (Medical) PsychologistTaxonomy code 103TP0016X

License

203430 Issued in ID

Practice address

90 Hope Dr BLDG 6000
Mountain Home Afb, ID 83648-1062

Phone

(208) 828-7581

NPI assigned

Mar 18, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Ms. Joanna Elise Temple Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1300406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760572800000",
    "number": "1063711869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9169 W STATE ST STE 725",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837141733",
            "telephone_number": "208-828-7581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 HOPE DR BLDG 6000",
            "city": "MOUNTAIN HOME AFB",
            "state": "ID",
            "postal_code": "836481062",
            "telephone_number": "208-828-7581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIESE",
        "first_name": "JOANNA",
        "middle_name": "ELISE",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-18",
        "last_updated": "2025-10-16",
        "certification_date": "2025-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TP0016X",
            "taxonomy_group": "",
            "desc": "Psychologist, Prescribing (Medical)",
            "state": "ID",
            "license": "203430",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JOANNA",
            "last_name": "TEMPLE",
            "middle_name": "ELISE",
            "prefix": "MS.",
            "credential": "PHD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Colton Toups, MD
• Easton Johnson Trejo, DDS
• Conrad Chase Trimble
• Terrance Valdespino
• Erin Ward, LCSW-C
• Ryan J Wilkes, DMD
• Shannon L Wilson, LCSW
• Tyree Wolf, IDMT

• Prescribing (Medical) Psychologist in Mountain Home Afb, ID
• Providers in Mountain Home Afb, ID by specialty
• Prescribing (Medical) Psychologist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2025; 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.