Active NPI
Nathaniel Wilson, PHARM D.
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- Johnson City, TN
National Provider Identifier
1053922195
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- License
- 0000042121
- Practice address
- 429 N State of Franklin Rd
Johnson City, TN 37604-6034 - Phone
- (423) 975-0068
- Fax
- (423) 975-0061
- NPI assigned
- Aug 12, 2020
- Last updated
- Aug 13, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | NU | ||
| Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | 0000042121 | TN | Primary |
Addresses
Primary practice location
429 N State of Franklin Rd
Johnson City, TN 37604-6034
Mailing address
429 N State of Franklin Rd
Johnson City, TN 37604-6034
Phone (423) 975-0068
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0000042121 | TN | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Pharmacy | Current | Accepting new patients |
| Walgreen Co | Pharmacy | Past | Accepting new patients |
Locations
429 N State of Franklin Rd
Johnson City, TN 37604
Phone (423) 975-0068
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1597190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597276800000",
"number": "1053922195",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "429 N STATE OF FRANKLIN RD",
"city": "JOHNSON CITY",
"state": "TN",
"postal_code": "376046034",
"telephone_number": "423-975-0068",
"fax_number": "423-975-0061"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "429 N STATE OF FRANKLIN RD",
"city": "JOHNSON CITY",
"state": "TN",
"postal_code": "376046034",
"telephone_number": "423-975-0068",
"fax_number": "423-975-0061"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "NATHANIEL",
"name_prefix": "Dr.",
"credential": "PHARM D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-08-12",
"last_updated": "2020-08-13",
"certification_date": "2020-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "1835P0018X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
"state": "TN",
"license": "0000042121",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Johnson City, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 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.