Active NPI
Katie Wilson, AGACNP-BC
- Gerontology Nurse Practitioner
- Danville, IL
National Provider Identifier
1073031100
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gerontology Nurse Practitioner
- License
- 209.016522
- Practice address
- 1900 E Main St
Danville, IL 61832-5100 - Phone
- (217) 554-4364
- NPI assigned
- Sep 8, 2017
- 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 |
|---|---|---|---|---|
| Gerontology Nurse Practitioner | 363LG0600X | 209.016522 | IL | Primary |
Addresses
Primary practice location
1900 E Main St
Danville, IL 61832-5100
Mailing address
1900 E Main St
Danville, IL 61832-5100
Phone (217) 554-4364
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1504828800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1551744000000",
"number": "1073031100",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1900 E MAIN ST",
"city": "DANVILLE",
"state": "IL",
"postal_code": "618325100",
"telephone_number": "217-554-4364"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1900 E MAIN ST",
"city": "DANVILLE",
"state": "IL",
"postal_code": "618325100",
"telephone_number": "217-554-4364"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "KATIE",
"credential": "AGACNP-BC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-09-08",
"last_updated": "2019-03-05",
"status": "A"
},
"taxonomies": [
{
"code": "363LG0600X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Gerontology",
"state": "IL",
"license": "209.016522",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Danville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.