Jack Larry Wisdom, CSA

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

718316 Issued in CA

Practice address

5974 Pentz Rd
Paradise, CA 95969-5509

Phone

(530) 876-7903

NPI assigned

Feb 21, 2014

Last updated

Feb 21, 2014By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1392940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392940800000",
    "number": "1376968750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "261 TRANQUIL DR",
            "city": "PARADISE",
            "state": "CA",
            "postal_code": "959693707",
            "telephone_number": "530-876-8533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5974 PENTZ RD",
            "city": "PARADISE",
            "state": "CA",
            "postal_code": "959695509",
            "telephone_number": "530-876-7903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISDOM",
        "first_name": "JACK",
        "middle_name": "LARRY",
        "credential": "CSA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-02-21",
        "last_updated": "2014-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "718316",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TN",
            "license": "96534",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William Wilbur, MSPT, OCS
• Caleb Walter Wilner
• Robert Brian Wilson
• Thomas Austin Wilson
• Stacy Winchell, N.P.
• Darin Peter Wood
• Neils Christian Wright
• Dia Yang
• Harry Patrick Yasko
• Kristen Lacy Yoder

• Registered Nurse in Paradise, CA
• Providers in Paradise, CA by specialty
• Registered Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2014; 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.