Individual
KELLI MARIE WISEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
125 S MAIN CROSS ST, LOUISA, KY 41230-1065
(606) 638-0938
(859) 813-5394
Mailing address
125 S MAIN CROSS ST, LOUISA, KY 41230-1065
(606) 638-0938
(859) 813-5394
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
KY
Other
Enumeration date
04/11/2023
Last updated
06/08/2024
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