ROBERT WISDOM (NPI# 1063456721) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063456721 |
| Entity Type | Individual |
| Full Name | ROBERT WISDOM |
| Credential | LMLP, LCP |
| Practice Address |
1558 Hayes Dr Manhattan KS 66502-5068 |
| Mailing Address |
Po Box 747 Manhattan KS 66505-0747 |
| Practice Telephone | 7855874315 |
| Practice Fax Number | 7855874339 |
| Mailing Telephone | 7855874300 |
| Mailing Fax Number | 7855874377 |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2013-01-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101Y00000X | Counselor | 0157 | KS | Behavioral Health & Social Service Providers |
| N | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
130 | KS | Behavioral Health & Social Service Providers |
| Y | 101YP2500X |
Counselor Specialization: Professional |
1438 | KS | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KS | 200441350A | 05 | |
| KS | BCBS | 856662 | 01 |
| CAQH | 11654652 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487767117 | Robert Anthony Wisdom | Nurse Practitioner | 4444 S Prairie Ave, Chicago, IL 60653-3208 | 2006-08-16 |
| Street Address |
1558 HAYES DR |
| City | MANHATTAN |
| State | KS |
| Zip Code | 66502-5068 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417567199 | Emily Hanson | Social Worker | 1558 Hayes Dr, Manhattan, KS 66502-5068 | 2020-08-06 |
| 1629612478 | Latanya Marie Butler-palmer | Social Worker | 1558 Hayes Dr, Manhattan, KS 66502-5068 | 2019-11-05 |
| 1184190217 | Kim Daniels | Counselor | 1558 Hayes Dr, Manhattan, KS 66502-5068 | 2018-10-16 |
| 1427561927 | Mark Anthony Maldonado | Counselor | 1558 Hayes Dr, Manhattan, KS 66502-5068 | 2017-11-07 |
| 1598281230 | Susan R Jording | Counselor | 1558 Hayes Dr, Manhattan, KS 66502-5068 | 2017-08-15 |
| 1326562588 | Cassandra L Myskiw | Counselor | 1558 Hayes Dr, Manhattan, KS 66502-5068 | 2017-07-31 |
| 1952824500 | Alison C Klem-creagar | Counselor | 1558 Hayes Dr, Manhattan, KS 66502-5068 | 2017-07-25 |
| 1942755236 | Jessica L Blasi | Counselor | 1558 Hayes Dr, Manhattan, KS 66502-5068 | 2016-08-17 |
| 1396193538 | Eric James Martin | Counselor | 1558 Hayes Dr, Manhattan, KS 66502-5068 | 2016-05-27 |
| 1194194811 | Stacy Conner | Counselor | 1558 Hayes Dr, Manhattan, KS 66502-5068 | 2015-09-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184232217 | Rebecca Anne Cherry | Marriage & Family Therapist | 1506 Browning Avenue, Suite 107, Manhattan, KS 66502 | 2020-07-15 |
| 1992334361 | Lorin C Kelly | Counselor | 201 South 4th Street, Suite C5, Manhattan, KS 66502 | 2020-04-07 |
| 1306487947 | Emily Trausch | Specialist/Technologist | 18 Ahearn Fieldhouse, Manhattan, KS 66502 | 2019-10-04 |
| 1730741018 | Jessica Caroline Kostroske | Speech-Language Pathologist | 2031 Poyntz Avenue, Manhattan, KS 66502 | 2019-07-08 |
| 1962968420 | Sarah C Siders | Social Worker | 1506 Browning Avenue #107, Manhattan, KS 66502 | 2019-02-20 |
| 1215408331 | Sara E Gotchey | Registered Nurse | 2100 Claflin Rd, Manhattan, KS 66502 | 2018-12-16 |
| 1306315601 | Gail Elizabeth Webster | Midwife, Lay | 2106 Timber Creek Dr, Manhattan, KS 66502 | 2018-11-15 |
| 1972021525 | Patience Ivy | Student in an Organized Health Care Education/Training Program | 1615 Denison Ave, Apt 211, Manhattan, KS 66502 | 2017-09-05 |
| 1578086252 | Alexa Jean Sharr | Physician Assistant | 1404 Beechwood Ter Ste C and D, Manhattan, KS 66502 | 2017-07-25 |
| 1790226702 | Mackenzie Getz | Student in an Organized Health Care Education/Training Program | 2465 Vaughn Dr, Manhattan, KS 66502 | 2017-03-10 |
| Find all providers in zip 66502 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336611284 | Blue Opal Counseling and Art Therapy LLC | Counselor | 323 Poyntz Ave Ste 203, Manhattan, KS 66502-6304 | 2018-12-17 |
| 1265902118 | Anita Kay Peterman | Counselor | 5336 Kewley Ln, Manhattan, KS 66503-8463 | 2018-12-03 |
| 1811497530 | Jamie Lynn Guelker | Counselor | 426 Houston St, Manhattan, KS 66502-6136 | 2018-02-19 |
| 1962778068 | Jessica Joan Callahan | Counselor | 310 Kay St, Manhattan, IL 60442-9278 | 2012-03-22 |
| 1215162839 | Kristen Monet Ramirez | Counselor | 1115 Westport Dr Ste D4, Manhattan, KS 66502-2871 | 2009-05-27 |
| 1972783405 | Erin Nichole Mellies | Counselor | 222 Southwind Pl, Manhattan, KS 66503 | 2007-11-13 |
| 1790842581 | Bridget Lee Woolbaugh | Counselor | 610 East Manhattan Avenue, Manhattan, MT 59741-0553 | 2007-01-02 |
| 1639782451 | Melodi Howard | Counselor | 1115 Westport Dr Ste D2, Manhattan, KS 66502-2880 | 2020-08-31 |
| 1487110722 | Nicole Medaris | Counselor | 1408 Poyntz Ave, Manhattan, KS 66502-4145 | 2019-02-12 |
| 1982184198 | Paul A Maxfield | Counselor | 2001 Claflin Rd, Manhattan, KS 66502-3415 | 2018-08-16 |
| Find all providers in MANHATTAN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.