NPIMap

Individual provider Active NPI

Brianna Jean Wilson, DNP, ARNP

  • Family Nurse Practitioner
  • La Conner, WA
National Provider Identifier
1083047369
Registry record updated Jan 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP60404988 Issued in WA
Practice address
708 E Morris St
Ste B
La Conner, WA 98257-9825
Phone
(360) 630-5141
Fax
(877) 850-2373
NPI assigned
Aug 9, 2013
Last updated
Jan 15, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X AP60404988 WA Primary

Addresses

Primary practice location

708 E Morris St
Ste B
La Conner, WA 98257-9825

Mailing address

PO Box 2104
La Conner, WA 98257-2104
Phone (360) 630-5141

Other identifiers 1

IdentifierTypeStateIssuer
1083047369MedicaidWA

Other names 1

  • Brianna Jean Bowe Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131015001940 WA Practitioner - Nurse Practitioner 5698909109 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Fern Lane Company LLCGroup PAC ID 0840540159, 2 clinicians

Practice addresses (Care Compare)

708 E Morris St
Suite B
La Conner, WA 98257-2104
Phone (360) 630-5141

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP60404988WAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Public Hospital Dist No 1 Skagit CurrentSince Jun 26, 2017 Accepting new patients
Public Hospital Dist No 1 Skagit Current Accepting new patients
Fern Lane Company, LLC CurrentSince Mar 22, 2017 Accepting new patients
Telecare Mental Health Services of Washington, Inc. CurrentSince Mar 3, 2018 Accepting new patients
Telecare Mental Health Services of Washington, Inc Current Accepting new patients
Public Hospital Dist No 1 Skagit CurrentSince Jun 26, 2017 Accepting new patients
Telecare Mental Health Services of Washington Inc CurrentSince Mar 3, 2018 Accepting new patients

Locations

1080 Marina Village Pkwy
Ste 100
Alameda, CA 94501
Phone (510) 306-5660

1400 E Kincaid St
Mount Vernon, WA 98274
Phone (360) 428-2586

9601 Steilacoom Blvd SW
Bldg 27
Tacoma, WA 98498
Phone (253) 589-5334

Organizations & group practices 7

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1376006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579046400000",
    "number": "1083047369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2104",
            "city": "LA CONNER",
            "state": "WA",
            "postal_code": "982572104",
            "telephone_number": "360-630-5141",
            "fax_number": "866-302-7491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "708 E MORRIS ST",
            "address_2": "STE B",
            "city": "LA CONNER",
            "state": "WA",
            "postal_code": "982579825",
            "telephone_number": "360-630-5141",
            "fax_number": "877-850-2373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "BRIANNA",
        "middle_name": "JEAN",
        "credential": "DNP, ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-09",
        "last_updated": "2020-01-15",
        "certification_date": "2020-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP60404988",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1083047369",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BRIANNA",
            "last_name": "BOWE",
            "middle_name": "JEAN",
            "credential": "RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in La Conner, WA

Sources for this page

Verify at the official NPI Registry.