Active NPI
Brent Wilson
- Physician Assistant
- Rocky Mount, NC
National Provider Identifier
1114461357
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 0010-07077
- Practice address
- 2460 Curtis Ellis Dr
Rocky Mount, NC 27804-2237 - Phone
- (252) 885-2463
- NPI assigned
- Dec 7, 2016
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Physician Assistant | 363A00000X | 0010-07077 | NC | Primary |
Addresses
Primary practice location
2460 Curtis Ellis Dr
Rocky Mount, NC 27804-2237
Mailing address
4518 Harvest LN SW
Wilson, NC 27893-9699
Phone (252) 885-2463
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0010-07077 | NC | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1481068800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1486944000000",
"number": "1114461357",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4518 HARVEST LN SW",
"city": "WILSON",
"state": "NC",
"postal_code": "278939699",
"telephone_number": "252-885-2463"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2460 CURTIS ELLIS DR",
"city": "ROCKY MOUNT",
"state": "NC",
"postal_code": "278042237",
"telephone_number": "252-885-2463"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "BRENT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-12-07",
"last_updated": "2017-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NC",
"license": "0010-07077",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rocky Mount, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.