DR. MARK EDWIN WISNER PH.D. PA-C NPI 1598771586

NPI Information

NPI: 1598771586
Provider Name: DR. MARK EDWIN WISNER, PH.D., PA-C
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

Address:
4101 S 4TH ST
VAMC RM. A541
LEAVENWORTH, KS
ZIP 66048
Phone: (913) 758-5416
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DR. Mark Edwin Wisner, PH.D., PA-C is a medical physician assistant in Leavenworth, KS. DR. Mark Edwin Wisner, PH.D., PA-C NPI is 1598771586. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

4101 S 4TH ST
VAMC RM. A541
LEAVENWORTH, KS
ZIP 66048-014
Phone: (913) 758-5416
Fax: (913) 758-4219

The enumeration date for this NPI number is 7/31/2006 and was last updated on 9/23/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AS0400X	Physician Assistant	Surgical	PA-15-000385	KANSAS	No
2	363AM0700X	Physician Assistant	Medical	PA 15-000385	KANSAS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	426715	OTHER	KANSAS	BLUE CROSS/BLUE SHIELD
2	100099480A	MEDICARE ID-TYPE UNSPECIFIED	KANSAS
3	S55198	MEDICARE UPIN	KANSAS
4	100340730A	MEDICAID	KANSAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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