Wound Company Provider Group, P.a.

Primary specialty

Wound Care Registered NurseTaxonomy code 163WW0000X

Legal business name

WOUND COMPANY PROVIDER GROUP, P.A.

Practice address

2240 Drew Ave S
Minneapolis, MN 55416-3646

Phone

(858) 774-6305

NPI assigned

Dec 7, 2022

Organization subpart

No

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

Authorized official

Name

Brantley Tilman Jolly Jr., MD

Title

President

Phone

(703) 447-6897

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1670371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670371200000",
    "number": "1225749542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2240 DREW AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554163646",
            "telephone_number": "858-774-6305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2240 DREW AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554163646",
            "telephone_number": "858-774-6305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOUND COMPANY PROVIDER GROUP, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-07",
        "last_updated": "2022-12-07",
        "certification_date": "2022-12-05",
        "status": "A",
        "authorized_official_last_name": "JOLLY",
        "authorized_official_first_name": "BRANTLEY",
        "authorized_official_middle_name": "TILMAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "703-447-6897",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "163WC2100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Continence Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WE0900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Enterostomal Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WW0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Wound Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donald Dwight Wothe, MD
• Evan Keith Wotipka
• Stacia Rene Wotring, RN
• Kacie Nicole Wottreng, CRNA
• Wound Company Provider Group, Inc.
• Debisa Kenate Woyessa Sr.
• Tiffany Woynilko, RN
• Hannah Woytek
• Jeffrey R Wozniak, PHD
• Wraparound House Calls, LLC

• Wound Care Registered Nurse in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Wound Care Registered Nurse in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2022; 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.