Stephanie Caroline Wilson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA.0004711 Issued in CO

Practice address

1551 Professional LN
Suite 220
Longmont, CO 80501-6972

Phone

(720) 279-9098

NPI assigned

Sep 29, 2016

Last updated

Feb 13, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Stephanie Caroline Raup Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1475107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486944000000",
    "number": "1235688300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1551 PROFESSIONAL LN",
            "address_2": "SUITE 220",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805016972",
            "telephone_number": "720-279-9098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1551 PROFESSIONAL LN",
            "address_2": "SUITE 220",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805016972",
            "telephone_number": "720-279-9098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "STEPHANIE",
        "middle_name": "CAROLINE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-29",
        "last_updated": "2017-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0004711",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36125083",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STEPHANIE",
            "last_name": "RAUP",
            "middle_name": "CAROLINE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jazmine Nicole Wilson
• Jennifer Wilson
• Maxwell S Wilson
• Megan Wilson
• Rodger Paul Wilson, RPH
• Janet Pearce Winchester, OTR
• Windler Chiropractic P.C.
• Joseph Windler, D.C.
• Leila Wing, M.D.
• Travis Daniel Wingate

• Physician Assistant in Longmont, CO
• Providers in Longmont, CO by specialty
• Physician Assistant in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 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.