JESSICA DANIELLE KEALA WISE DNP, CNM, PMHNP
NPI 1912413428
Nurse Practitioner - Psychiatric/Mental Health in Charlotte, NC

Q: What is Jessica Wise's NPI number?

The NPI number for Jessica Wise is 1912413428. It was assigned to this individual provider in the NPPES registry on December 19, 2017.

Q: What is Jessica Wise's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Q: When was this NPI record last updated?

The NPPES record for Jessica Wise was last updated on February 10, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since December 19, 2017PECOS EnrolledAccepts Medicare Assignment

4412 PARK RD STE B, CHARLOTTE, NC 28209(617) 379-0496 Get Directions Write a Review

NPPES record last updated: February 10, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: May 20, 2025, May 6, 2025, Sep 18, 2024 and 4 more (7 updates tracked since 2017).

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About Jessica Danielle Keala Wise Dnp, Cnm, Pmhnp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JESSICA DANIELLE KEALA WISE DNP, CNM, PMHNP (NPI 1912413428) is an individual psychiatric/mental health provider in Charlotte, North Carolina, licensed in North Carolina (5020240) and active in the NPI registry since December 2017. She is enrolled in Medicare PECOS, maintains a secondary practice location in Charlotte, and is a graduate of Other (2017).

NPPES Registry Identity

NPI1912413428

Entity TypeIndividualFemale

Primary Taxonomy363LP0808X

Provider Legal NameJESSICA DANIELLE KEALA WISECredential: DNP, CNM, PMHNP

Location Address4412 PARK RD STE BCharlotte, NC 28209-3130

Mailing Address4412 Park RdCharlotte, NC 28209-3130 · (617) 379-0496

Phone(617) 379-0496

Sole ProprietorNo

Medical School CMSOtherGraduated 2017

Enumeration DateDecember 19, 2017

Last NPPES UpdateFebruary 10, 20267 updates tracked since enumeration

NPPES CertifiedFebruary 10, 2026

✔ NPI 1912413428 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LP0808X

License✔ Licensed in NC · 5020240

Also ListedAdvanced Practice MidwifeTaxonomy 367A00000X

4412 PARK RD STE B, Charlotte, NC 28209

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Secondary Practice Location 1

Location 1501 Billingsley RdCharlotte, NC 28211-1009 · Phone (704) 358-2800

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of NC, Oscar Health Plan of North Carolina, Inc, UnitedHealthcare.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Jessica Danielle Keala Wise Dnp, Cnm, Pmhnp is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID648535815

PECOS Enrollment IDI20241203004069

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 28209 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$83.90 typical visit price

range $54.12 – $165.09

Typical copayment $20.97 (range $13.53 – $41.27)

Most-billed visit code 99203

Established Patient

$95.94 typical visit price

range $17.21 – $134.61

Typical copayment $23.98 (range $4.30 – $33.65)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JOSEPHINE ANN LOUISE RANA LCSW

Social Worker (Clinical)