Provider Demographics
NPI:1952287724
Name:WISE, STACY ALISON SANDERS (RN, PHN, FNP-C)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:ALISON SANDERS
Last Name:WISE
Suffix:
Gender:F
Credentials:RN, PHN, FNP-C
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:ALISON
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 6086
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93290-6086
Mailing Address - Country:US
Mailing Address - Phone:559-824-5297
Mailing Address - Fax:
Practice Address - Street 1:520 W MINERAL KING AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-6142
Practice Address - Country:US
Practice Address - Phone:949-332-6180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA568136163W00000X
CA95016686363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse