Individual
TROY D WISEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
12A IDELLA LN, CONWAY, AR 72032-9587
(501) 697-7036
Mailing address
12A IDELLA LN, CONWAY, AR 72032-9587
(501) 697-7036
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
927290469
AR
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
87-2206707
—
AR
Enumeration date
11/09/2021
Last updated
06/27/2022
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