Jessica Lynn Wisdom, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

71007325A Issued in IN

Practice address

650 Dickinson Rd
Chesterton, IN 46304-3387

Phone

(219) 926-7755

Fax

(219) 929-1885

NPI assigned

Jun 26, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IN

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

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• La Porte Clinic Company LLC

  • Internal Medicine Physician
  • Valparaiso, IN
  • NPI 1568829224
  Medicare reassignment NPD
• Porter Physician Services LLC

  • Family Medicine Physician
  • Valparaiso, IN
  • NPI 1508075680
  Medicare reassignment NPD
• La Porte Clinic Company LLC

  • Durable Medical Equipment & Medical Supplies
  • La Porte, IN
  • NPI 1275081788
  NPD
• Porter Physician Services LLC

  • Internal Medicine Physician
  • Portage, IN
  • NPI 1457566309
  NPD (past)

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

{
    "created_epoch": "1498435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623196800000",
    "number": "1790205292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2022 KELLE DR",
            "city": "CHESTERTON",
            "state": "IN",
            "postal_code": "463048708",
            "telephone_number": "219-364-3616",
            "fax_number": "219-364-3610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 DICKINSON RD",
            "city": "CHESTERTON",
            "state": "IN",
            "postal_code": "463043387",
            "telephone_number": "219-926-7755",
            "fax_number": "219-929-1885"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "492 S Bierma St",
            "address_purpose": "LOCATION",
            "city": "Wheatfield",
            "state": "IN",
            "postal_code": "46392",
            "country_code": "US",
            "telephone_number": "219-956-2110",
            "fax_number": "219-956-3548",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "492 S Bierma St",
            "address_purpose": "LOCATION",
            "city": "Wheatfield",
            "state": "IN",
            "postal_code": "46392",
            "country_code": "US",
            "telephone_number": "219-956-2110",
            "fax_number": "219-956-3548",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "809 LaPorte Ave Ste B",
            "address_purpose": "LOCATION",
            "city": "Valparaiso",
            "state": "IN",
            "postal_code": "463835801",
            "country_code": "US",
            "telephone_number": "219-263-4977",
            "fax_number": "219-263-4979",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3630 Willowcreek Rd",
            "address_purpose": "LOCATION",
            "city": "Portage",
            "state": "IN",
            "postal_code": "463685075",
            "country_code": "US",
            "telephone_number": "219-364-3900",
            "fax_number": "219-364-3959",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3988 W State Road 10",
            "address_purpose": "LOCATION",
            "city": "Wheatfield",
            "state": "IN",
            "postal_code": "46392",
            "country_code": "US",
            "telephone_number": "219-987-3581",
            "fax_number": "219-987-7137",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "401 NewPorte Blvd",
            "address_purpose": "LOCATION",
            "city": "La Porte",
            "state": "IN",
            "postal_code": "463504099",
            "country_code": "US",
            "telephone_number": "219-575-6244",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3777 N Frontage Rd Ste 500",
            "address_purpose": "LOCATION",
            "city": "Michigan City",
            "state": "IN",
            "postal_code": "463607697",
            "country_code": "US",
            "telephone_number": "219-809-2889",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WISDOM",
        "first_name": "JESSICA",
        "middle_name": "LYNN",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-26",
        "last_updated": "2021-06-09",
        "certification_date": "2021-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "28187239A",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71007325A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jessica.wisdom.1@2340.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "AMR direct address",
            "address_1": "650 Dickinson Rd",
            "city": "Chesterton",
            "state": "IN",
            "country_code": "US",
            "postal_code": "463043387",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Clatossica Williams
• Pamela Williams, COTA
• Sarah Williams
• Courtney Wilson, RBT
• Michelle J Wilson, RPH
• Cynthia Withrow, RPT
• Vivian R.C. Witter, LCSW
• Nichole Wolff, RBT
• John W.S. Wong, RPH.
• Patricia L Wong

• Family Nurse Practitioner in Chesterton, IN
• Providers in Chesterton, IN by specialty
• Family Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.