Justin Wilder, RN

Primary specialty

Addiction (Substance Use Disorder) Registered NurseTaxonomy code 163WA0400X

License

930303 Issued in TX

Practice address

201 Lavaca St
Austin, TX 78701-3960

Phone

(754) 234-0938

NPI assigned

Oct 14, 2017

Last updated

Oct 14, 2017By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1507939200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1507939200000",
    "number": "1144731357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 LAVACA ST",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787013960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 LAVACA ST",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787013960",
            "telephone_number": "754-234-0938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDER",
        "first_name": "JUSTIN",
        "name_prefix": "Mr.",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-10-14",
        "last_updated": "2017-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WA0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Addiction (Substance Use Disorder)",
            "state": "TX",
            "license": "930303",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dapo Wilde
• Jessica Wilde, PA-C
• Wilder Wellness PLLC (Doing Good Therapy PLLC)
• Alfred Christian Wilder, MD
• Andrea Wilder
• Katharina Ingeborg Leonore Wilder, APRN-C
• Olivia Jo Wilder, ANP
• Tyler Craig Wildey, DDS
• Wildflower Pediatrics, PA
• Wildflower Psychotherapy PLLC

• Addiction (Substance Use Disorder) Registered Nurse in Austin, TX
• Providers in Austin, TX by specialty
• Addiction (Substance Use Disorder) Registered Nurse in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 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.

Verify at the official NPI Registry.