Active NPI
Crystal Wise
- Registered Nurse
- Prospect, VA
National Provider Identifier
1548834625
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 0001290756
- Practice address
- 520 Tuggle Rd
Prospect, VA 23960-7919 - Phone
- (434) 509-5235
- Fax
- (434) 223-1423
- NPI assigned
- May 13, 2021
- Last updated
- May 13, 2021
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 0001290756 | VA | Primary |
Addresses
Primary practice location
520 Tuggle Rd
Prospect, VA 23960-7919
Mailing address
520 Tuggle Rd
Prospect, VA 23960-7919
Phone (434) 509-5235
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0001290756 | Other | VA | LICENSE |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | gr8nurse2017@gmail.com |
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 |
|---|---|---|---|
| 0001290756 | VA | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wisest Heart, LLC | Registered Nurse | Current | Accepting new patients |
Organizations & group practices 1
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": "1620864000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1620864000000",
"number": "1548834625",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "520 TUGGLE RD",
"city": "PROSPECT",
"state": "VA",
"postal_code": "239607919",
"telephone_number": "434-509-5235",
"fax_number": "434-223-1423"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "520 TUGGLE RD",
"city": "PROSPECT",
"state": "VA",
"postal_code": "239607919",
"telephone_number": "434-509-5235",
"fax_number": "434-223-1423"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WISE",
"first_name": "CRYSTAL",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-05-13",
"last_updated": "2021-05-13",
"certification_date": "2021-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "VA",
"license": "0001290756",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "0001290756",
"state": "VA"
}
],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "gr8nurse2017@gmail.com",
"affiliation": "N",
"address_1": "520 Tuggle Rd",
"city": "Prospect",
"state": "VA",
"country_code": "US",
"postal_code": "239607919",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Prospect, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.