Wallette Gwen Widener, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

RN113693 Issued in GA

Practice address

6602 Waters Ave BLDG C
Savannah, GA 31406-2716

Phone

(912) 354-7676

Fax

(912) 790-6456

NPI assigned

Aug 25, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

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

Specialty

Nurse Practitioner

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Savannah Neurology Specialists P CGroup PAC ID 8224175641, 15 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Joseph'S Hospital - Savannah Hospital, Savannah, GA, CCN 110043

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Savannah Neurology Specialists P C

  • Neurology Physician
  • Savannah, GA
  • NPI 1629203294

  GA

  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Saint Joseph'S Hospital, Inc.

  • General Acute Care Hospital
  • Savannah, GA
  • NPI 1063406684

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1280966400000",
    "number": "1669580262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6602 WATERS AVE BLDG C",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314062716",
            "telephone_number": "912-354-7676",
            "fax_number": "912-790-6456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6602 WATERS AVE BLDG C",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314062716",
            "telephone_number": "912-354-7676",
            "fax_number": "912-790-6456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIDENER",
        "first_name": "WALLETTE",
        "middle_name": "GWEN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-25",
        "last_updated": "2010-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN113693",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "410170417A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Kim Whyte, LPC
• Dabney Taylor Wickham
• John D Wiebe, DDS
• Cassidy Jo Wiggins, PA-C
• Laura Nicole Wiggins, NP
• Lisa Michelle Wiggins, LPC
• Norma Elaine Wiggins, LMT

• All providers in Savannah, GA
• Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.