Active NPI
Amber Tanisha Wilson, CPHT
- Other Technician
- Reynoldsburg, OH
National Provider Identifier
1023388923
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Other Technician
- License
- 5101-0701-0102-808
- Practice address
- 7070 Tomahawk TRL
Reynoldsburg, OH 43068-4806 - Phone
- (614) 517-9587
- NPI assigned
- Jan 9, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Other Technician | 247200000X | 5101-0701-0102-808 | OH | Primary |
Addresses
Primary practice location
7070 Tomahawk TRL
Reynoldsburg, OH 43068-4806
Mailing address
7070 Tomahawk TRL
Reynoldsburg, OH 43068-4806
Phone (614) 517-9587
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 45-2758598 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5101-0701-0102-808 | OH | MD | Other Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1326067200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1326067200000",
"number": "1023388923",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7070 TOMAHAWK TRL",
"city": "REYNOLDSBURG",
"state": "OH",
"postal_code": "430684806",
"telephone_number": "614-517-9587"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7070 TOMAHAWK TRL",
"city": "REYNOLDSBURG",
"state": "OH",
"postal_code": "430684806",
"telephone_number": "614-517-9587"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "AMBER",
"middle_name": "TANISHA",
"name_prefix": "Ms.",
"credential": "CPHT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-01-09",
"last_updated": "2012-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "247200000X",
"taxonomy_group": "",
"desc": "Technician, Other",
"state": "OH",
"license": "5101-0701-0102-808",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "45-2758598",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Reynoldsburg, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.