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

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: November 01, 2026.

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

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
Open in Google Maps ↗

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, Cigna Healthcare, Oscar Health Plan of North Carolina, Inc and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

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.

Medicare Billing Reassignments

2

Medicare enrollment records show Jessica Wise reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Carolinas Medical Center
1.9 mi
Internal Medicine
1350 S KINGS DR
Charlotte, NC 28207
  • Reassigned Medicare billing, North Carolina enrollment
  • 2,223 clinicians in this Medicare group
NPI 1073754131 (704) 446-1242
Pediatric And Family Behavioral Health, PLLC
23 mi
Child & Adolescent Psychiatry
1111 CIRCLE DR
Monroe, NC 28112
  • Reassigned Medicare billing, North Carolina enrollment
  • 8 clinicians in this Medicare group
NPI 1700385507 (704) 764-1818

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 7

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)
4412 PARK RD STE B
CHARLOTTE, NC 28209
Mecklenburg County (855) 284-7483
JAIMIE BROWN LCSW
Social Worker (Clinical)
4412 PARK RD STE B
CHARLOTTE, NC 28209
Mecklenburg County (855) 675-4144
SARAH ZYCH MSW
Social Worker (Clinical)
4412 PARK RD STE B
CHARLOTTE, NC 28209
Mecklenburg County (855) 675-4144
ERICKA GENESIS JARVIS M.S., LCMHC
Counselor (Mental Health)
4412 PARK RD STE B
CHARLOTTE, NC 28209
Mecklenburg County (631) 416-1319
ANNA BREAISHA MAYES LCMHC
Counselor (Mental Health)
4412 PARK RD STE B
CHARLOTTE, NC 28209
Mecklenburg County (980) 217-6901
DIANE YOLANDE BURKE
Counselor (Mental Health)
4412 PARK RD STE B
CHARLOTTE, NC 28209
Mecklenburg County (980) 217-6901
MR. WILLIAM TRENT HABEN LCSW
Social Worker (Clinical)
4412 PARK RD STE B
CHARLOTTE, NC 28209
Mecklenburg County (855) 675-4144

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

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.

Where is Jessica Wise located?

Jessica Wise practices at 4412 Park Rd Ste B, Charlotte, NC 28209. The listed phone number is (617) 379-0496.

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.

Is Jessica Wise enrolled in Medicare?

Yes. Jessica Wise is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Jessica Wise's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jessica Wise reassigns Medicare benefits to 2 organizations: Carolinas Medical Center (Charlotte, NC) and Pediatric And Family Behavioral Health, PLLC (Monroe, NC). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jessica Wise's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Jessica Wise accept?

Health plans from Blue Cross and Blue Shield of NC, Cigna Healthcare, Oscar Health Plan of North Carolina, Inc and UnitedHealthcare list Jessica Wise as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

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 8 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.