Active NPI
Kristal Wilson
- Mental Illness Community Based Residential Treatment Facility
- Reno, NV
National Provider Identifier
1134533862
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Illness Community Based Residential Treatment Facility
- License
- 4100647854
- Practice address
- 2470 Wrondel Way Ste 275
Reno, NV 89502-3701 - Phone
- (775) 354-3991
- Fax
- (775) 336-1082
- NPI assigned
- Jun 20, 2014
- 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 |
|---|---|---|---|---|
| Mental Illness Community Based Residential Treatment Facility | 320800000X | 4100647854 | NV | Primary |
Addresses
Primary practice location
2470 Wrondel Way Ste 275
Reno, NV 89502-3701
Mailing address
2470 Wrondel Way Ste 275
Reno, NV 89502-3701
Phone (775) 354-3991
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 |
|---|---|---|---|
| 4100647854 | NV | MD | Mental Illness Community Based Residential Treatment Facility |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1403222400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1403222400000",
"number": "1134533862",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2470 WRONDEL WAY STE 275",
"city": "RENO",
"state": "NV",
"postal_code": "895023701",
"telephone_number": "775-354-3991",
"fax_number": "775-336-1082"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2470 WRONDEL WAY STE 275",
"city": "RENO",
"state": "NV",
"postal_code": "895023701",
"telephone_number": "775-354-3991",
"fax_number": "775-336-1082"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "KRISTAL",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-06-20",
"last_updated": "2014-06-20",
"status": "A"
},
"taxonomies": [
{
"code": "320800000X",
"taxonomy_group": "",
"desc": "Community Based Residential Treatment Facility, Mental Illness",
"state": "NV",
"license": "4100647854",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Reno, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.