Active NPI
Reva A Wilson
- Pharmacist
- Tyler, TX
National Provider Identifier
1205118981
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 49157
- Practice address
- 1620 S Broadway Ave
Tyler, TX 75701-4260 - Phone
- (903) 533-0667
- NPI assigned
- Sep 19, 2011
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 49157 | TX | Primary |
Addresses
Primary practice location
1620 S Broadway Ave
Tyler, TX 75701-4260
Mailing address
5348 Old Jacksonville Hwy
Apt 1309
Tyler, TX 75703-3350
Phone (504) 235-1679
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 |
|---|---|---|---|
| 49157 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1316390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316390400000",
"number": "1205118981",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5348 OLD JACKSONVILLE HWY",
"address_2": "APT 1309",
"city": "TYLER",
"state": "TX",
"postal_code": "757033350",
"telephone_number": "504-235-1679"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1620 S BROADWAY AVE",
"city": "TYLER",
"state": "TX",
"postal_code": "757014260",
"telephone_number": "903-533-0667"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "REVA",
"middle_name": "A",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-09-19",
"last_updated": "2011-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "49157",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.