Terry Lucas Willson, ATC, CSCS

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AL 3139 Issued in FL

Practice address

1325 San Marco Blvd
Jacksonville, FL 32207-8568

Phone

(904) 858-7045

NPI assigned

Sep 3, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1251936000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1313452800000",
    "number": "1235362443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "355 MONUMENT RD",
            "address_2": "13-C",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322256486",
            "telephone_number": "801-866-2800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 SAN MARCO BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322078568",
            "telephone_number": "904-858-7045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLSON",
        "first_name": "TERRY",
        "middle_name": "LUCAS",
        "credential": "ATC, CSCS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-09-03",
        "last_updated": "2011-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "PA",
            "license": "RT004553",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "FL",
            "license": "AL 3139",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ATHLETIC TRAINER",
            "identifier": "22",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ATHLETIC TRAINER",
            "identifier": "22",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Willows Tree Behavioral Health
• Gwendolyn Ong Wills, RPH
• Jordan Marie Wills, NP
• Sofia Wills, MA
• Sarah Willson
• Kayla Marie Demus Wilmot, PA
• Tania Anntoinette Wilson-Ocran
• Alyssa Wilson
• Andrea Nicole Wilson, CNP
• Andria Wilson, PT, DPT

• Athletic Trainer in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Athletic Trainer in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 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.

Verify at the official NPI Registry.