Individual
MR. RICHARD GOODMAN WISEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
538 J M ASH DR, HOLLY SPRINGS, MS 38635-3238
(662) 252-1599
Mailing address
538 J M ASH DR, HOLLY SPRINGS, MS 38635-3238
(662) 252-1599
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R549096
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00114188
—
MS
Enumeration date
09/20/2006
Last updated
07/08/2007
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