Mark Edwin Wisner, PH.D., PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA 15-000385 Issued in KS

Practice address

4101 S 4TH St
Vamc RM. A541
Leavenworth, KS 66048-5014

Phone

(913) 758-5416

Fax

(913) 758-4219

NPI assigned

Jul 31, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Physician Assistant, Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285200000000",
    "number": "1598771586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4101 S 4TH ST",
            "address_2": "VAMC RM. A541",
            "city": "LEAVENWORTH",
            "state": "KS",
            "postal_code": "660485014",
            "telephone_number": "913-758-5416",
            "fax_number": "913-758-4219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4101 S 4TH ST",
            "address_2": "VAMC RM. A541",
            "city": "LEAVENWORTH",
            "state": "KS",
            "postal_code": "660485014",
            "telephone_number": "913-758-5416",
            "fax_number": "913-758-4219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISNER",
        "first_name": "MARK",
        "middle_name": "EDWIN",
        "name_prefix": "Dr.",
        "credential": "PH.D., PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-31",
        "last_updated": "2010-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "KS",
            "license": "PA 15-000385",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "KS",
            "license": "PA-15-000385",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100340730A",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "426715",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rosemarie Nicole Wilson, LCSW
• Callee Winder
• Megan Jean Winstead, RN
• Karen Lee Winter, MD
• Rebecca J. Wirth, LMSW
• Brandy Ona Witter, BSN, RN
• Thomas C Wolfe, LCAC
• Ron Wollenhaupt, ATC, LAT
• Tristan Wolters
• Womens Clinic Associates PA

• Medical Physician Assistant in Leavenworth, KS
• Providers in Leavenworth, KS by specialty
• Medical Physician Assistant in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.