Active NPI
Kristin Wilson
- Peer Specialist
- Redding, CA
National Provider Identifier
1063113330
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- MPSS-CRZHGO
- Practice address
- 2640 Breslauer Way
Redding, CA 96001-4246 - Phone
- (530) 225-5200
- NPI assigned
- Mar 14, 2023
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | |||
| Peer Specialist | 175T00000X | MPSS-CRZHGO | CA | Primary |
Addresses
Primary practice location
2640 Breslauer Way
Redding, CA 96001-4246
Mailing address
2640 Breslauer Way
Redding, CA 96001-4246
Phone (530) 225-5200
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 |
|---|---|---|---|
| MPSS-CRZHGO | CA | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1678752000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1730246400000",
"number": "1063113330",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2640 BRESLAUER WAY",
"city": "REDDING",
"state": "CA",
"postal_code": "960014246",
"telephone_number": "530-225-5200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2640 BRESLAUER WAY",
"city": "REDDING",
"state": "CA",
"postal_code": "960014246",
"telephone_number": "530-225-5200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "KRISTIN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-03-14",
"last_updated": "2024-10-30",
"certification_date": "2024-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": false
},
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "CA",
"license": "MPSS-CRZHGO",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Redding, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.