Brandon James Wilson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA01268 Issued in RI

Practice address

Uscg Base Kodiak Rockmore-King Clinic
200 Albatross Ave BLDG N-46
Kodiak, AK 99615-6810

Phone

(907) 487-5757

NPI assigned

Feb 9, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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": "1549670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597881600000",
    "number": "1043775414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "37 CEDARWOOD CT",
            "city": "PHENIX CITY",
            "state": "AL",
            "postal_code": "368704801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "USCG BASE KODIAK ROCKMORE-KING CLINIC",
            "address_2": "200 ALBATROSS AVE BLDG N-46",
            "city": "KODIAK",
            "state": "AK",
            "postal_code": "996156810",
            "telephone_number": "907-487-5757"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6600 Van Aalst Blvd",
            "address_purpose": "LOCATION",
            "city": "Fort Benning",
            "state": "GA",
            "postal_code": "319052102",
            "country_code": "US",
            "telephone_number": "762-408-2605",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "BRANDON",
        "middle_name": "JAMES",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-02-09",
        "last_updated": "2020-08-20",
        "certification_date": "2020-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "RI",
            "license": "PA01268",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Desiree Alexis Wheeler, OD
• Roxann Marie White, MSPT
• Joel Gregory Wiersum Sr., DDS
• Dorianne Emily Williams, FNP
• Wendell Hayden Wilmoth, M.D.
• Evelyn Wiszinckas, PH.D.
• Melissa Witteveen, PA-C
• Alan W Wolf, MD
• Diane C Wolkoff
• Rebecca Lynn Wolkoff

• Physician Assistant in Kodiak, AK
• Providers in Kodiak, AK by specialty
• Physician Assistant in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2020; 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.