Individual
MS. JORDAN WISEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1 SUGAR CREEK CENTER BLVD STE 618, SUGAR LAND, TX 77478-3540
(832) 655-4141
(713) 457-5188
Mailing address
1 SUGAR CREEK CENTER BLVD STE 618, SUGAR LAND, TX 77478-3540
(832) 655-4141
(713) 457-5188
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA12258
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8KE884
BCBS - XCITE SURGICAL
TX
01
—
8KE885
BCBS - UNIVERSAL SURGICAL ASSISTANTS
TX
01
—
8KE886
BCBS - UNIVERSAL SURGICAL PARTNERS
TX
01
—
8LI002
BCBS - BLUE STAR SURGICAL ASSISTANTS LLC
TX
01
—
PA12258
TEXAS MEDICAL BOARD
TX
Enumeration date
09/28/2018
Last updated
01/29/2020
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