Active NPI
James Wilson Jr.
- Personal Care Attendant
- Marianna, AR
National Provider Identifier
1063577682
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Personal Care Attendant
- License
- 32903
- Practice address
- 1679 Highway 243 South
Marianna, AR 72360 - Phone
- (870) 295-3557
- Fax
- (870) 295-3686
- NPI assigned
- Dec 26, 2006
- 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 |
|---|---|---|---|---|
| Personal Care Attendant | 3747P1801X | 32903 | AR | Primary |
| Lodging Provider | 177F00000X | 101 | AR |
Addresses
Primary practice location
1679 Highway 243 South
Marianna, AR 72360
Mailing address
1679 Highway 243 South
Marianna, AR 72360
Phone (870) 295-3557
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 121812732 | Medicaid | AR |
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 |
|---|---|---|---|
| 101 | AR | MD | Podiatrist |
| 32903 | AR | MD | Personal Care Attendant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wilson Residential Care | Lodging | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167091200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1735257600000",
"number": "1063577682",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1679 HIGHWAY 243 SOUTH",
"city": "MARIANNA",
"state": "AR",
"postal_code": "72360",
"telephone_number": "870-295-3557",
"fax_number": "870-295-3686"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1679 HIGHWAY 243 SOUTH",
"city": "MARIANNA",
"state": "AR",
"postal_code": "72360",
"telephone_number": "870-295-3557",
"fax_number": "870-295-3686"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "JAMES",
"name_suffix": "Jr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-26",
"last_updated": "2024-12-27",
"certification_date": "2024-12-27",
"status": "A"
},
"taxonomies": [
{
"code": "3747P1801X",
"taxonomy_group": "",
"desc": "Technician, Personal Care Attendant",
"state": "AR",
"license": "32903",
"primary": true
},
{
"code": "177F00000X",
"taxonomy_group": "",
"desc": "Lodging",
"state": "AR",
"license": "101",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "121812732",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Marianna, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 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.