Active NPI
Jennifer Kelly Wilson, DNP, RN, CPNP-PC
- Pediatric Nurse Practitioner
- Brookline, MA
National Provider Identifier
1093581423
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- 2363283
- Practice address
- 1600 Beacon St Apt 312
Brookline, MA 02446-2223 - Phone
- (203) 339-2161
- NPI assigned
- Nov 27, 2023
- 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 |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | 2363283 | MA | Primary |
Addresses
Primary practice location
1600 Beacon St Apt 312
Brookline, MA 02446-2223
Mailing address
1600 Beacon St Apt 312
Brookline, MA 02446-2223
Phone (203) 339-2161
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
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2363283 | MA | MD | Pediatric Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1701043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701129600000",
"number": "1093581423",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1600 BEACON ST APT 312",
"city": "BROOKLINE",
"state": "MA",
"postal_code": "024462223",
"telephone_number": "203-339-2161"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1600 BEACON ST APT 312",
"city": "BROOKLINE",
"state": "MA",
"postal_code": "024462223",
"telephone_number": "203-339-2161"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "JENNIFER",
"middle_name": "KELLY",
"credential": "DNP, RN, CPNP-PC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-11-27",
"last_updated": "2023-11-28",
"certification_date": "2023-11-28",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "MA",
"license": "2363283",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brookline, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.