Active NPI
Latoya Wilson
- Family Nurse Practitioner
- Middle River, MD
National Provider Identifier
1104685122
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- F03240036
- Practice address
- 9826 Decatur Rd
Middle River, MD 21220-3777 - Phone
- (410) 240-0174
- NPI assigned
- Mar 14, 2024
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | F03240036 | MD | Primary |
Addresses
Primary practice location
9826 Decatur Rd
Middle River, MD 21220-3777
Mailing address
9826 Decatur Rd
Middle River, MD 21220-3777
Phone (410) 240-0174
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 |
|---|---|---|---|
| F03240036 | MD | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1710374400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1710374400000",
"number": "1104685122",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9826 DECATUR RD",
"city": "MIDDLE RIVER",
"state": "MD",
"postal_code": "212203777",
"telephone_number": "410-240-0174"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9826 DECATUR RD",
"city": "MIDDLE RIVER",
"state": "MD",
"postal_code": "212203777",
"telephone_number": "410-240-0174"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "LATOYA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-03-14",
"last_updated": "2024-03-14",
"certification_date": "2024-03-13",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Nurse Practitioner, Family",
"state": "MD",
"license": "F03240036",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Middle River, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.