Jeffrey Lynn Wilson, FNP-BC

Primary specialty

Family Health Clinical Nurse SpecialistTaxonomy code 364SF0001X

License

19891 Issued in TN

Practice address

5516 Barons PT
Ooltewah, TN 37363-8875

Phone

(423) 987-5333

NPI assigned

Apr 8, 2015

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mr. Jeff Lynn Wilson Other name

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Theoria Medical

  • Internal Medicine Physician
  • Novi, MI
  • NPI 1609362375

  TN

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1428451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1428451200000",
    "number": "1073909883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5516 BARONS PT",
            "city": "OOLTEWAH",
            "state": "TN",
            "postal_code": "373638875",
            "telephone_number": "423-987-5333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5516 BARONS PT",
            "city": "OOLTEWAH",
            "state": "TN",
            "postal_code": "373638875",
            "telephone_number": "423-987-5333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JEFFREY",
        "middle_name": "LYNN",
        "name_prefix": "Mr.",
        "credential": "FNP-BC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-04-08",
        "last_updated": "2015-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SF0001X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Family Health",
            "state": "TN",
            "license": "19891",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JEFF",
            "last_name": "WILSON",
            "middle_name": "LYNN",
            "prefix": "MR.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Hannah Elizabeth White, BSN, FNP-BC
• Kenia White, LMSW, LCSWA
• Whole Soul Healing Inc
• Cassie Ann Williams, FNP
• Terry Lee Williams Jr., D.O.
• Rhonda Wilson, LPC-MHSP
• Cheryl Lynn Wiltse, O.D.
• Sarah Jessica Wingo, DPT
• Erica Lynn Winter
• David R Winters, DO

• Family Health Clinical Nurse Specialist in Ooltewah, TN
• Providers in Ooltewah, TN by specialty
• Family Health Clinical Nurse Specialist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2015; 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.

Verify at the official NPI Registry.