DR. KATHLEEN MARIE WIESE (NPI# 1790987923) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790987923 |
| Entity Type | Individual |
| Full Name | DR. KATHLEEN MARIE WIESE |
| Credential | D.O. |
| Practice Address |
3333 Silas Creek Pkwy Winston Salem NC 27103-3013 |
| Mailing Address |
Po Box 60447 Charlotte NC 28260-0447 |
| Practice Telephone | 3367187597 |
| Practice Fax Number | 3367187598 |
| Mailing Telephone | 3367187597 |
| Mailing Fax Number | 3367187598 |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2020-10-25 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
2007-01475 | NC | Allopathic & Osteopathic Physicians |
| N | 2084V0102X |
Psychiatry & Neurology Specialization: Vascular Neurology |
2007-01475 | NC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | BCBS NC | 1457P | 01 |
| NC | NC MED BOARD LICENSE | 2007-01475 | 01 |
| NC | RAILROAD MEDICARE | P00414192 | 01 |
| NC | 5907596 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1222 Medical Center Dr, Wilmington, NC 284017307 | 9103413383 | 9103413321 |
| Street Address |
3333 SILAS CREEK PKWY |
| City | WINSTON SALEM |
| State | NC |
| Zip Code | 27103-3013 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700880440 | Joy L Csikos | Physician Assistant | 3333 Silas Creek Pkwy, Winston Salem, NC 27103-3013 | 2005-06-10 |
| 1861092421 | Madison Ann Cline | Physician Assistant | 3333 Silas Creek Pkwy, Winston Salem, NC 27103-3013 | 2020-10-31 |
| 1285241083 | Erin Elphick | Physician Assistant | 3333 Silas Creek Pkwy, Winston Salem, NC 27103-3013 | 2020-09-25 |
| 1851909626 | Alex Joseph Holton | Registered Nurse | 3333 Silas Creek Pkwy, Winston Salem, NC 27103-3013 | 2020-07-17 |
| 1497370191 | Karen Shugart | Nurse Practitioner | 3333 Silas Creek Pkwy, Winston Salem, NC 27103-3013 | 2020-06-09 |
| 1831721299 | Brianna Elaine Marks | Nurse Practitioner | 3333 Silas Creek Pkwy, Winston Salem, NC 27103-3013 | 2020-02-04 |
| 1952946659 | Jennifer Michelle Lucio | Nurse Practitioner | 3333 Silas Creek Pkwy, Winston Salem, NC 27103-3013 | 2019-11-18 |
| 1336799527 | Novant Medical Group, Inc. | Obstetrics & Gynecology | 3333 Silas Creek Pkwy, Winston Salem, NC 27103-3013 | 2019-09-19 |
| 1467001503 | Hannah Dibble Palmer | Nurse Practitioner | 3333 Silas Creek Pkwy, Winston Salem, NC 27103-3013 | 2019-09-11 |
| 1659926012 | Jamie Kornelis Hobson | Registered Nurse | 3333 Silas Creek Pkwy, Winston Salem, NC 27103-3013 | 2019-08-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124648126 | Kelly Anne Wales | Pharmacist | 3917-a Westpoint Boulevard, Winston-salem, NC 27103 | 2020-04-20 |
| 1386281533 | Elena Mcginty | Nurse Practitioner | 1225 Creekshire Way, Suite 270, Winston Salem, NC 27103 | 2019-12-06 |
| 1992359442 | Madeline Pryor | Pharmacist | 255 Charlois Drive, Winston Salem, NC 27103 | 2019-08-01 |
| 1215599584 | Palmetto Oxygen LLC | Durable Medical Equipment & Medical Supplies | 1100 S Stratford Road, Building B, Suite 420, Winston Salem, NC 27103 | 2019-07-07 |
| 1548734718 | Trivy Johnson | Specialist | 1384-b Westgate Center Dr., Winston Salem, NC 27103 | 2019-01-21 |
| 1447745047 | Novant Health Rehabilitation Hospital of Winston-salem, LLC | Rehabilitation Hospital | 2475 Hillcrest Center Circle, Winston Salem, NC 27103 | 2018-06-26 |
| 1346740206 | Joseph Miller | Physical Therapist | 1605 Westbrook Dr, Suite 103, Winston-salem, NC 27103 | 2018-02-17 |
| 1548779101 | Kristin Blow | Counselor | 3000 Bethesda Pl Ste 202, Winston Salem, NC 27103 | 2017-09-27 |
| 1891213443 | Alisha Dawn Wilson | Occupational Therapy Assistant | 2101 Homestead Hills Drive, Winston Salem, NC 27103 | 2017-09-05 |
| 1588186969 | Brandy Wilson | Social Worker | 153 Cameron Way Circle, Winston Salem, NC 27103 | 2017-07-07 |
| Find all providers in zip 27103 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811417835 | Arvind Muralimohan Gomadam | Psychiatry & Neurology | 1492 Rymco Dr, Winston Salem, NC 27103 | 2017-06-21 |
| 1760802474 | Michael Verenes | Psychiatry & Neurology | 2025 Frontis Plaza Blvd Ste 120, Winston Salem, NC 27103 | 2014-04-21 |
| 1245539212 | David Hosford | Psychiatry & Neurology | 200 E 1st St Ste 300, Winston Salem, NC 27101-4165 | 2011-03-16 |
| 1447334388 | Margaret Louise Craig | Psychiatry & Neurology | 1915 Cadman Forest Drive, Winston Salem, NC 27127-4684 | 2006-10-25 |
| 1841848249 | Novant Medical Group Inc | Psychiatry & Neurology | 190 Kimel Park Dr Ste 131, Winston Salem, NC 27103-6946 | 2019-08-28 |
| 1043713910 | Novant Medical Group, Inc. | Psychiatry & Neurology | 3333 Silas Creek Pkwy, Winston Salem, NC 27103-3013 | 2018-03-16 |
| 1134656143 | Novant Medical Group Inc | Psychiatry & Neurology | 190 Kimel Park Dr Ste 121, Winston Salem, NC 27103-6946 | 2017-05-22 |
| 1649655028 | Devanshi Dharaiya | Psychiatry & Neurology | 3333 Silas Creek Pkwy, Winston Salem, NC 27103 | 2015-07-27 |
| 1780063958 | Novant Medical Group, Inc. | Psychiatry & Neurology | 2025 Frontis Plaza Blvd, Suite 120, Winston Salem, NC 27103-5663 | 2015-05-21 |
| 1568857480 | Tamra Ishan Jayendra Ranasinghe | Psychiatry & Neurology | Medical Center Blvd, Winston Salem, NC 27157-9180 | 2015-03-30 |
| Find all providers in WINSTON SALEM | ||||
| City | WINSTON SALEM |
| Zip Code | 27103 |
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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.