Active NPI
Wilson Pershing Stevenson III
- Contractor
- Richland, WA
National Provider Identifier
1093202053
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- 601942637
- Practice address
- 3250 Port of Benton Blvd Ste D
Richland, WA 99354-1670 - Phone
- (509) 371-2570
- Fax
- (866) 880-2576
- NPI assigned
- Apr 16, 2018
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 601942637 | WA | Primary |
Addresses
Primary practice location
3250 Port of Benton Blvd Ste D
Richland, WA 99354-1670
Mailing address
3250 Port of Benton Blvd Ste D
Richland, WA 99354-1670
Phone (509) 371-2570
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 |
|---|---|---|---|
| 601942637 | WA | MD | Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1523836800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1523836800000",
"number": "1093202053",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3250 PORT OF BENTON BLVD STE D",
"city": "RICHLAND",
"state": "WA",
"postal_code": "993541670",
"telephone_number": "509-371-2570",
"fax_number": "866-880-2576"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3250 PORT OF BENTON BLVD STE D",
"city": "RICHLAND",
"state": "WA",
"postal_code": "993541670",
"telephone_number": "509-371-2570",
"fax_number": "866-880-2576"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STEVENSON",
"first_name": "WILSON",
"middle_name": "PERSHING",
"name_prefix": "Mr.",
"name_suffix": "III",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-04-16",
"last_updated": "2018-04-16",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "WA",
"license": "601942637",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Richland, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.