Jackelyn Marie Wiser, APRN- FNP-BC is a medicare enrolled "Nurse Practitioner - Family" in Goodfellow Afb, Texas. Her current practice location is
271 Ft Richardson Ave, Goodfellow Afb, Texas. You can reach out to her office (for appointments etc.) via phone at
(325) 654-5391.
Jackelyn Marie Wiser is licensed to practice in Texas (license number 1103582) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1669170908.
Provider's Profile
| Full Name | Jackelyn Marie Wiser |
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| Gender | Female |
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| Speciality | Nurse Practitioner - Family |
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| Location | 271 Ft Richardson Ave, Goodfellow Afb, Texas |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1669170908
- Provider Enumeration Date: 02/16/2023
- Last Update Date: 06/28/2023
Medicare PECOS Information:
- PECOS PAC ID: 3274077045
- Enrollment ID: I20240703002397
Medical Identifiers
Medical identifiers for Jackelyn Marie Wiser such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1669170908 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 363LF0000X | Nurse Practitioner - Family | 1103582 (Texas) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Jackelyn Marie Wiser allows following entities to bill medicare on her behalf.
| Entity Name | Shannon Clinic |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1770587149
PECOS PAC ID: 0840103727
Enrollment ID: O20031222000702 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jackelyn Marie Wiser is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Jackelyn Marie Wiser, APRN- FNP-BC
271 Ft Richardson Ave,
Goodfellow Afb, TX 76908
Ph: (325) 654-5391 | Jackelyn Marie Wiser, APRN- FNP-BC
271 Ft Richardson Ave,
Goodfellow Afb, TX 76908
Ph: (325) 654-5391 |
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