Wanda Faye Wilson

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

6906542 Issued in FL

Practice address

2510 St Augustine Rd
Monticello, FL 32344-6938

Phone

(850) 780-0426

NPI assigned

Aug 13, 2013

Last updated

Aug 13, 2013By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1376352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376352000000",
    "number": "1043643133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2510 ST AUGUSTINE RD",
            "city": "MONTICELLO",
            "state": "FL",
            "postal_code": "323446938",
            "telephone_number": "850-780-0426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2510 ST AUGUSTINE RD",
            "city": "MONTICELLO",
            "state": "FL",
            "postal_code": "323446938",
            "telephone_number": "850-780-0426"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "WANDA",
        "middle_name": "FAYE",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-08-13",
        "last_updated": "2013-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "FL",
            "license": "6906542",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004873400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Natalia Johanna Waters
• Rachelle Denise Wells, D.M.D
• Jennifer Alyse Wigglesworth, RN
• Angie Beach Williams, R.PH.
• Clinton Brad Wilson
• Anna Elyse Thames Yarbrough Powers, MS

• Adult Care Home Facility in Monticello, FL
• Providers in Monticello, FL by specialty
• Adult Care Home Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.