Active NPI
Stacy Johnson Wiseman, RD, LDN
- Obesity and Weight Management Nutrition Registered Dietitian
- Rock Hill, SC
National Provider Identifier
1295464402
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obesity and Weight Management Nutrition Registered Dietitian
- License
- 571
- Practice address
- 4007 Mt Gallant Rd
Rock Hill, SC 29732-9635 - Phone
- (803) 323-7505
- NPI assigned
- Jun 6, 2022
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Obesity and Weight Management Nutrition Registered Dietitian | 133VN1201X | 571 | SC | Primary |
Addresses
Primary practice location
4007 Mt Gallant Rd
Rock Hill, SC 29732-9635
Mailing address
4007 Mt Gallant Rd
Rock Hill, SC 29732-9635
Phone (803) 323-7505
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 571 | SC | MD | Pediatric Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1654473600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1654473600000",
"number": "1295464402",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4007 MT GALLANT RD",
"city": "ROCK HILL",
"state": "SC",
"postal_code": "297329635",
"telephone_number": "803-323-7505"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4007 MT GALLANT RD",
"city": "ROCK HILL",
"state": "SC",
"postal_code": "297329635",
"telephone_number": "803-323-7505"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WISEMAN",
"first_name": "STACY",
"middle_name": "JOHNSON",
"name_prefix": "Mrs.",
"credential": "RD, LDN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-06-06",
"last_updated": "2022-06-06",
"certification_date": "2022-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "133VN1201X",
"taxonomy_group": "",
"desc": "Dietitian, Registered, Nutrition, Obesity and Weight Management",
"state": "SC",
"license": "571",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rock Hill, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.