NPIMap

Individual provider Active NPI

Emily J Wiseman, FNP

  • Family Nurse Practitioner
  • Licking, MO
National Provider Identifier
1700327897
Registry record updated Feb 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
2016041028 Issued in MO
Practice address
139 W Highway 32
Licking, MO 65542-9898
Phone
(573) 674-3011
Fax
(573) 674-4765
NPI assigned
Mar 9, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2026

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 2016041028 MO Primary

Addresses

Primary practice location

139 W Highway 32
Licking, MO 65542-9898

Mailing address

139 W Highway 32
Licking, MO 65542-9898
Phone (573) 674-3011

Other identifiers 2

IdentifierTypeStateIssuer
26D0679044OtherMOCLIA
420041775MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170427000425 MO Practitioner - Nurse Practitioner 5092092197 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pcrmc Medical Group IncGroup PAC ID 1557454063, 113 clinicians
Texas County Memorial HospitalGroup PAC ID 9436041696, 30 clinicians

Practice addresses (Care Compare)

1000 W 10TH St
Rolla, MO 65401-2905
Phone (573) 458-8899

1050 W 10TH St
Rolla, MO 65401-2905
Phone (573) 364-9000

139 W Hwy 32
Licking, MO 65542-9898
Phone (573) 674-3011

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2016041028MOMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Phelps County Regional Medical Center CurrentSince Mar 1, 2020 Accepting new patients
Texas County Memorial Hospital CurrentSince Feb 11, 2026 Accepting new patients
Texas County Memorial Hospital CurrentSince Feb 11, 2026 Accepting new patients
Phelps County Regional Medical Center CurrentSince Apr 1, 2017 Accepting new patients
Pcrmc Medical Group, Inc CurrentSince Apr 1, 2017 Accepting new patients
Texas County Memorial Hospital Past Accepting new patients
Ozarks Medical Center Past Accepting new patients
Texas County Memorial Hospital Past Accepting new patients

Locations

1333 S Sam Houston Blvd
Houston, MO 65483
Phone (417) 967-3311

139 W Highway 32
Licking, MO 65542
Phone (573) 674-3011

1050 W 10th St
Rolla, MO 65401
Phone (573) 364-9000

1000 W 10th St
Rolla, MO 65401
Phone (573) 364-9000

Organizations & group practices 8

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.

Hospital & facility affiliations 8

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

NPI Registry JSON

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

{
    "created_epoch": "1489017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770768000000",
    "number": "1700327897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "139 W HIGHWAY 32",
            "city": "LICKING",
            "state": "MO",
            "postal_code": "655429898",
            "telephone_number": "573-674-3011",
            "fax_number": "573-674-4765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "139 W HIGHWAY 32",
            "city": "LICKING",
            "state": "MO",
            "postal_code": "655429898",
            "telephone_number": "573-674-3011",
            "fax_number": "573-674-4765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISEMAN",
        "first_name": "EMILY",
        "middle_name": "J",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-09",
        "last_updated": "2026-02-11",
        "certification_date": "2026-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2016041028",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "26D0679044",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "420041775",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Licking, MO

Sources for this page

Verify at the official NPI Registry.