Active NPI
Jennifer Kathryn Wilson, M.D.
- Psychiatry Physician
- Eureka, CA
National Provider Identifier
1053575936
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- A64309
- Practice address
- 720 Wood St
Eureka, CA 95501 - Phone
- (707) 268-2939
- NPI assigned
- Jul 10, 2008
- 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | A64309 | CA | Primary |
Addresses
Primary practice location
720 Wood St
Eureka, CA 95501
Mailing address
720 Wood St
Humboldt County Mental Health
Eureka, CA 95501
Phone (707) 268-2900
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 64309 | CA | MD | Pharmacist |
| A64309 | CA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1215648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1306800000000",
"number": "1053575936",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "720 WOOD ST",
"address_2": "HUMBOLDT COUNTY MENTAL HEALTH",
"city": "EUREKA",
"state": "CA",
"postal_code": "95501",
"telephone_number": "707-268-2900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "720 WOOD ST",
"city": "EUREKA",
"state": "CA",
"postal_code": "95501",
"telephone_number": "707-268-2939"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "JENNIFER",
"middle_name": "KATHRYN",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-07-10",
"last_updated": "2011-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "A64309",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eureka, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.