Active NPI
Kimberly Tai Wise, DEM
- Midwife
- Lebanon, OR
National Provider Identifier
1134411788
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Midwife
- Practice address
- 966 Cleveland St
Lebanon, OR 97355-4422 - Phone
- (541) 401-1667
- NPI assigned
- May 13, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Midwife | 176B00000X | Primary |
Addresses
Primary practice location
966 Cleveland St
Lebanon, OR 97355-4422
Mailing address
966 Cleveland St
Lebanon, OR 97355-4422
Phone (541) 401-1667
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1305244800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1305244800000",
"number": "1134411788",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "966 CLEVELAND ST",
"city": "LEBANON",
"state": "OR",
"postal_code": "973554422",
"telephone_number": "541-401-1667"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "966 CLEVELAND ST",
"city": "LEBANON",
"state": "OR",
"postal_code": "973554422",
"telephone_number": "541-401-1667"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WISE",
"first_name": "KIMBERLY",
"middle_name": "TAI",
"name_prefix": "Mrs.",
"credential": "DEM",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-05-13",
"last_updated": "2011-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "176B00000X",
"taxonomy_group": "",
"desc": "Midwife",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lebanon, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.