Basic Information
| Provider Information | |||||||||
| NPI: | 1144749276 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WIMAN | ||||||||
| FirstName: | KIERSTON | ||||||||
| MiddleName: | PAISLEY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DNP, APRN-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 318 BIRCH CT | ||||||||
| Address2: | |||||||||
| City: | CARROLLTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301164640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043268900 | ||||||||
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| Practice Location | |||||||||
| Address1: | 465 WINN WAY STE 221 | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300301723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042923810 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2017 | ||||||||
| LastUpdateDate: | 09/09/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | RN228540 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.