Laura Renae Wilson, MSN, APRN-BC

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

RN247115 Issued in GA

Practice address

5405 Memorial Dr Ste D
Stone Mountain, GA 30083-3236

Phone

(404) 296-3800

Fax

(404) 297-8753

NPI assigned

May 15, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 4

Other names 1

• Miss Laura Renae Phelps Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing

State licenses

Interoperability endpoints

• Direct secure messaging: laurawilson@tpc.allscriptsdirect.net

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

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551830400000",
    "number": "1104032218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5405 MEMORIAL DR STE D",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300833236",
            "telephone_number": "404-296-3800",
            "fax_number": "404-297-8753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5405 MEMORIAL DR STE D",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300833236",
            "telephone_number": "404-296-3800",
            "fax_number": "404-297-8753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "LAURA",
        "middle_name": "RENAE",
        "name_prefix": "Mrs.",
        "credential": "MSN, APRN-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-15",
        "last_updated": "2019-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CT",
            "license": "004365",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "701633",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "GA",
            "license": "RN247115",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI - BVCAA",
            "identifier": "1821185299",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI - ROBERTSON COUNTY CHC",
            "identifier": "1275620551",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "154467803",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI- BRYAN- COLLEGE STATION CHC",
            "identifier": "1649265646",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAURA",
            "last_name": "PHELPS",
            "middle_name": "RENAE",
            "prefix": "MISS",
            "credential": "MSN, APRN-BC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Latore Williams
• Lynell Williams, M.ED
• Sharon Williams
• Shashonia Williams
• Victoria Williams
• Wilson'S Wellness Clinical Care, LLC
• Annette Winkfield, MS, DCP, ST
• Stacy D Witherspoon
• Tadeusz K Wodecki, MD
• Jo Anne Woodall, APRN

• Primary Care Nurse Practitioner in Stone Mountain, GA
• Providers in Stone Mountain, GA by specialty
• Primary Care Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.