Jack Earl Wilcox, NURSE PRACTITIONER

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

5005586 Issued in NC

Practice address

120 Memorial Dr
Jacksonville, NC 28546-6328

Phone

(910) 353-0581

Fax

(910) 353-1536

NPI assigned

Jun 14, 2006

Sex

Male

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Family Care Clinic, P.a.

  • Clinic/Center
  • Jacksonville, NC
  • NPI 1316033590
  NPD (past)

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1436313600000",
    "number": "1265475347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 MEMORIAL DR",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285466328",
            "telephone_number": "910-353-0581",
            "fax_number": "910-353-1536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 MEMORIAL DR",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285466328",
            "telephone_number": "910-353-0581",
            "fax_number": "910-353-1536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILCOX",
        "first_name": "JACK",
        "middle_name": "EARL",
        "name_prefix": "Mr.",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-14",
        "last_updated": "2015-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NC",
            "license": "5005586",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7006283",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kaitlyn Whitmer
• Ann-Marie Arlene Whittaker, LMBT
• Cassidy Michelle Whoolery, LMBT
• Victoria Wicker
• Kelsey M.S. Wieduwilt, PT, DPT
• Robert Lee Wilder Jr., LCSW-A
• Meghan Elizabeth Wilker, MS
• Williams Outreach & Consulting Inc
• Natalie B Williams Tayman
• Angela Price Williams, CRNA

• Pediatric Nurse Practitioner in Jacksonville, NC
• Providers in Jacksonville, NC by specialty
• Pediatric Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2015; 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.