Provider Demographics
NPI:1063193514
Name:WISDOM, AMI ELIZABETH
Entity type:Individual
Prefix:
First Name:AMI
Middle Name:ELIZABETH
Last Name:WISDOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMI
Other - Middle Name:
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2560 OLD COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:AR
Mailing Address - Zip Code:72455-4118
Mailing Address - Country:US
Mailing Address - Phone:870-892-7111
Mailing Address - Fax:870-892-0930
Practice Address - Street 1:2560 OLD COUNTY RD
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:AR
Practice Address - Zip Code:72455-4118
Practice Address - Country:US
Practice Address - Phone:870-892-7111
Practice Address - Fax:870-892-0930
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator