Andreo Wilson

Primary specialty

Personal Care AttendantTaxonomy code 3747P1801X

Practice address

161 Rose LN
Drakes Branch, VA 23937-2508

Phone

(434) 515-1805

NPI assigned

May 9, 2022

Last updated

Jan 21, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• A W Wholesalers

  dba Simply Divine Facilitation Services, LLC

  • Case Management Agency
  • Drakes Branch, VA
  • NPI 1124758834
  NPD Authorized official

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

{
    "created_epoch": "1652054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674259200000",
    "number": "1124764527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "161 ROSE LN",
            "city": "DRAKES BRANCH",
            "state": "VA",
            "postal_code": "239372508",
            "telephone_number": "434-515-1805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "161 ROSE LN",
            "city": "DRAKES BRANCH",
            "state": "VA",
            "postal_code": "239372508",
            "telephone_number": "434-515-1805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "ANDREO",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-05-09",
        "last_updated": "2023-01-21",
        "certification_date": "2023-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "3747P1801X",
            "taxonomy_group": "",
            "desc": "Technician, Personal Care Attendant",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30017448820001",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30017448820002",
            "state": "VA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Simplydivinefs@gmail.com",
            "affiliation": "N",
            "address_1": "161 Rose Ln",
            "city": "Drakes Branch",
            "state": "VA",
            "country_code": "US",
            "postal_code": "239372508",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• 360 Transport LLC
• A W Wholesalers (Simply Divine Facilitation Services, LLC)
• Arnold None Gayles
• Ronald Gayles
• James Darwin Gregory Sr.

• Personal Care Attendant in Drakes Branch, VA
• Providers in Drakes Branch, VA by specialty
• Personal Care Attendant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 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.

Verify at the official NPI Registry.