NPIMap

Individual provider Active NPI

Jesalyn Dove Wilson, PA-C

  • Physician Assistant
  • Clarksville, AR
National Provider Identifier
1205226925
Registry record updated Jun 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
P-T1518 Issued in AR
Practice address
25 Professional Park Dr
Clarksville, AR 72830-4432
Phone
(479) 705-8181
Fax
(479) 705-0041
NPI assigned
Feb 2, 2015
Last updated
Jun 27, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X P-T1518 AR Primary

Addresses

Primary practice location

25 Professional Park Dr
Clarksville, AR 72830-4432

Mailing address

25 Professional Park Dr
Clarksville, AR 72830-4432
Phone (479) 746-1877

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150330001332 AR Practitioner - Physician Assistant 4183941255 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Robert Frederick Noonan Jr MD PAGroup PAC ID 5890892830, 5 clinicians

Practice addresses (Care Compare)

25 Professional Park Dr
Clarksville, AR 72830-4432
Phone (479) 705-8181

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
P-T1518ARMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University of Arkansas for Medical Sciences CurrentSince Mar 1, 2015 Accepting new patients
University of Arkansas for Medical Sciences CurrentSince Mar 1, 2015 Accepting new patients
Arkansas Children's Hospital CurrentSince Mar 1, 2015 Accepting new patients
Arkansas Childrens Hospital CurrentSince Mar 1, 2015 Accepting new patients
East Arkansas Emergency Physicians, PLLC Physician Assistant CurrentSince Jan 10, 2016 Accepting new patients
East Arkansas Emergency Physicians, PLLC Physician Assistant CurrentSince Jan 10, 2016 Accepting new patients
Johnson Regional Medical Center Past Accepting new patients

Locations

1520 N Division St
Blytheville, AR 72315
Phone (870) 838-7300

1100 E Poplar St
Clarksville, AR 72830
Phone (479) 754-5393

1100 E Poplar St
Ste C
Clarksville, AR 72830
Phone (479) 754-5454

1 Childrens Way
Little Rock, AR 72202
Phone (501) 364-1874

1 Childrens Way
#653
Little Rock, AR 72202
Phone (501) 614-2006

Interoperability endpoints

  • Direct secure messaging: jwilson@cfmc-ar.direct.office.nextgen.com

Organizations & group practices 9

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1422835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750982400000",
    "number": "1205226925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 PROFESSIONAL PARK DR",
            "city": "CLARKSVILLE",
            "state": "AR",
            "postal_code": "728304432",
            "telephone_number": "479-746-1877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 PROFESSIONAL PARK DR",
            "city": "CLARKSVILLE",
            "state": "AR",
            "postal_code": "728304432",
            "telephone_number": "479-705-8181",
            "fax_number": "479-705-0041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JESALYN",
        "middle_name": "DOVE",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-02-02",
        "last_updated": "2025-06-27",
        "certification_date": "2025-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AR",
            "license": "P-T1518",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarksville, AR

Sources for this page

Verify at the official NPI Registry.