Courtney Wiseman, PA
Individual provider Active NPI Physician Assistant · Jamestown, CA
NPI 1144769332 · NPPES record last updated Dec 12, 2023
Key facts
- NPI
- 1144769332
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 57620 (CA)
- Practice address
- 18144 Seco St
Jamestown, CA 95327-9498 - Phone
- (209) 984-4820
- Fax
- (209) 984-4825
- NPI assigned
- Feb 21, 2017
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 57620 | CA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Denver Springs Physician Group LLC | Past | Accepting new patients | |
| Denver Springs Physician Group, LLC | Past | Accepting new patients | |
| Mathiesen Memorial Health Center | Past |
Accepting new patients |
Interoperability endpoints
- courtney.wiseman.p1@direct.mathiesenmemorialhc.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 0010-07098 | NC | |
| Physician Assistant | 363A00000X | 57620 | CA | Yes |
Addresses
Primary practice location
18144 Seco St
Jamestown, CA 95327-9498
Mailing address
PO Box 60447
Charlotte, NC 28260-0447
Phone (704) 384-1246
Other practice location 1
1900 Randolph Rd
Suite 800
Charlotte, NC 28207-1122
Phone (704) 384-1246
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | cwiseman427863@direct.novanthealth.org | ||
| Direct Messaging Address | cwiseman1228520@wm.providencedirect.org |
Other providers in Jamestown, CA
- TNS, Inc
- Jennifer D Torres
- Debra Leann Townsend
- Gina M Valente-Moore
- Chantell Weir
- David Wormhood
- Randall Zimmerman
All providers in Jamestown, CA · Physician Assistant in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 12, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.