Courtney Wiseman, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

57620 Issued in CA

Practice address

18144 Seco St
Jamestown, CA 95327-9498

Phone

(209) 984-4820

Fax

(209) 984-4825

NPI assigned

Feb 21, 2017

Last updated

Dec 12, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: courtney.wiseman.p1@direct.mathiesenmemorialhc.nextgenshare.com
• Direct secure messaging: cwiseman1228520@wm.providencedirect.org
• Direct secure messaging: cwiseman427863@direct.novanthealth.org

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

• Mathiesen Memorial Health Center

  • Primary Care Clinic/Center
  • Jamestown, CA
  • NPI 1356080022
  NPD (past)
• Denver Springs Physician Group LLC

  • Psychiatry Physician
  • Englewood, CO
  • NPI 1144742016
  NPD (past)
• Denver Springs Physician Group, LLC

  • Psychiatry Physician
  • Englewood, CO
  • NPI 1851030795
  NPD (past)

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

{
    "created_epoch": "1487635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702339200000",
    "number": "1144769332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447",
            "telephone_number": "704-384-1246",
            "fax_number": "704-384-6072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18144 SECO ST",
            "city": "JAMESTOWN",
            "state": "CA",
            "postal_code": "953279498",
            "telephone_number": "209-984-4820",
            "fax_number": "209-984-4825"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1900 Randolph Rd",
            "address_2": "Suite 800",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282071122",
            "country_code": "US",
            "telephone_number": "704-384-1246",
            "fax_number": "704-384-6072",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WISEMAN",
        "first_name": "COURTNEY",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-02-21",
        "last_updated": "2023-12-12",
        "certification_date": "2023-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-07098",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "57620",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cwiseman427863@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "1900 Randolph Rd",
            "address_2": "Suite 800",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282071122",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cwiseman1228520@wm.providencedirect.org",
            "affiliation": "N",
            "address_1": "902 N Orange St Ste 202",
            "city": "Missoula",
            "state": "MT",
            "country_code": "US",
            "postal_code": "598022928",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• TNS, Inc (Casa Viejos Assisted Living)
• Jennifer D Torres, PPS
• Debra Leann Townsend, IBCLC
• Gina M Valente-Moore, FNP
• Chantell Weir, FNP
• David Wormhood, DDS
• Randall Zimmerman, DDS

• Physician Assistant in Jamestown, CA
• Providers in Jamestown, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2023; 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.