Active NPI
Christopher Wisdom
- Licensed Practical Nurse
- Shawnee, OK
National Provider Identifier
1184429318
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- L0060890
- Practice address
- 2307 Gordon Cooper Dr
Shawnee, OK 74801-9007 - Phone
- (405) 273-3263
- NPI assigned
- Feb 13, 2025
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | L0060890 | OK | Primary |
Addresses
Primary practice location
2307 Gordon Cooper Dr
Shawnee, OK 74801-9007
Mailing address
2307 Gordon Cooper Dr
Shawnee, OK 74801-9007
Phone (405) 273-3263
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L0060890 | OK | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1739404800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1739404800000",
"number": "1184429318",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2307 GORDON COOPER DR",
"city": "SHAWNEE",
"state": "OK",
"postal_code": "748019007",
"telephone_number": "405-273-3263"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2307 GORDON COOPER DR",
"city": "SHAWNEE",
"state": "OK",
"postal_code": "748019007",
"telephone_number": "405-273-3263"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WISDOM",
"first_name": "CHRISTOPHER",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-02-13",
"last_updated": "2025-02-13",
"certification_date": "2025-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "OK",
"license": "L0060890",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shawnee, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 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.