Individual
EMILY J WISEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
139 W HIGHWAY 32, LICKING, MO 65542-9898
(573) 674-3011
(573) 674-4765
Mailing address
139 W HIGHWAY 32, LICKING, MO 65542-9898
(573) 674-3011
(573) 674-4765
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2016041028
MO
363LF0000X
Family Nurse Practitioner
Primary
F1016776
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26D0679044
CLIA
MO
05
—
420041775
—
MO
Enumeration date
03/09/2017
Last updated
02/11/2026
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