Individual provider Active NPI

Carol Michelle Wiesner, NP

  • Family Nurse Practitioner
  • Fort Worth, TX
National Provider Identifier
1528832490
Registry record updated Oct 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
1154625 Issued in TX
Practice address
2000 Cooper St Ste 120
Fort Worth, TX 76104-2535
Phone
(817) 820-2890
Fax
(817) 810-0725
NPI assigned
Nov 13, 2023
Last updated
Oct 2, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 1154625 TX Primary

Addresses

Primary practice location

2000 Cooper St Ste 120
Fort Worth, TX 76104-2535

Mailing address

2000 Cooper St Ste 120
Fort Worth, TX 76104-2535
Phone (817) 820-2890

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251117000191 TX Practitioner - Nurse Practitioner 3476044678 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Texas Health Physicians GroupGroup PAC ID 4385535954, 1,364 clinicians

Practice addresses (Care Compare)

508 S Adams
Suite 100
Fort Worth, TX 76104-2151
Phone (817) 237-6311

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1154625TXMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Health Physicians Group Current Accepting new patients
Texas Health Physicians Group CurrentSince Dec 1, 2025 Accepting new patients
Texas Health Physicians Group CurrentSince Dec 1, 2025 Accepting new patients

Locations

1600 Hospital Pkwy
Bedford, TX 76022
Phone (817) 355-7803

508 S Adams St
Ste 100
Fort Worth, TX 76104
Phone (817) 332-5099

1325 Pennsylvania Ave
Ste 560
Ft Worth, TX 76104
Phone (817) 250-7240

2000 Cooper St
Ste 120
Ft Worth, TX 76104
Phone (817) 820-2890

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1699833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727827200000",
    "number": "1528832490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 COOPER ST STE 120",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761042535",
            "telephone_number": "817-820-2890",
            "fax_number": "817-810-0725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 COOPER ST STE 120",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761042535",
            "telephone_number": "817-820-2890",
            "fax_number": "817-810-0725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIESNER",
        "first_name": "CAROL",
        "middle_name": "MICHELLE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-11-13",
        "last_updated": "2024-10-02",
        "certification_date": "2024-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1154625",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.