Jarred Douglas Wilson, SURFACE IDC

Primary specialty

Independent Duty CorpsmanTaxonomy code 1710I1002X

Practice address

365 Gonzalez Blvd
Camp Lejeune, NC 28542

Phone

(910) 451-5846

NPI assigned

Oct 23, 2015

Last updated

Jul 2, 2025By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1445558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751414400000",
    "number": "1255703641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "365 GONZALEZ BLVD",
            "city": "CAMP LEJEUNE",
            "state": "NC",
            "postal_code": "28542",
            "telephone_number": "910-451-5846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "365 GONZALEZ BLVD",
            "city": "CAMP LEJEUNE",
            "state": "NC",
            "postal_code": "28542",
            "telephone_number": "910-451-5846"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JARRED",
        "middle_name": "DOUGLAS",
        "name_prefix": "Mr.",
        "credential": "SURFACE IDC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-10-23",
        "last_updated": "2025-07-02",
        "certification_date": "2025-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1002X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Corpsman",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Necia L Williams, M.D.
• Benjamin Carl Willis, RN, BSN
• Laura Wilmott, FNP
• Lela Wilson-Hammel
• Christopher E Wilson, M.D., M.P.H.
• Laurie Ann Wilson, PT, DPT
• Lisa Marie Wilson, M.S.W.,L.C.S.W., Q.P
• Spencer Curtis Wilson, DMD
• Ronald Jackson Winstead, PHARMD
• Nathan William Winter, DO

• Independent Duty Corpsman in Camp Lejeune, NC
• Providers in Camp Lejeune, NC by specialty
• Independent Duty Corpsman in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2025; 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.