Individual
DAVID WISEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
101 CLINIC DR, TARBORO, NC 27886-1935
(252) 823-2105
(252) 824-7653
Mailing address
101 CLINIC DR, TARBORO, NC 27886-1935
(252) 823-2105
(252) 824-7653
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
102519
NC
363A00000X
Physician Assistant
Primary
102519
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
136YA
BCBS
NC
05
—
89130F0
—
NC
Enumeration date
02/08/2007
Last updated
06/25/2026
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