Active NPI
Jon Darren Wilson, PA-C
- Physician Assistant
- Tucson, AZ
National Provider Identifier
1285885483
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 5770
- Practice address
- 3601 S 6TH Ave
Tucson, AZ 85723-0001 - Phone
- (520) 629-6613
- NPI assigned
- Oct 6, 2008
- Last updated
- Nov 14, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 2011040196 | MO | |
| Physician Assistant | 363A00000X | 085004141 | IL | |
| Physician Assistant | 363A00000X | 5770 | AZ | Primary |
Addresses
Primary practice location
3601 S 6TH Ave
Tucson, AZ 85723-0001
Mailing address
3601 S 6TH Ave
Tucson, AZ 85723-0001
Phone (520) 629-6613
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5770 | AZ | MD | Physician Assistant |
| 085004141 | IL | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1223251200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1447459200000",
"number": "1285885483",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3601 S 6TH AVE",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857230001",
"telephone_number": "520-629-6613"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3601 S 6TH AVE",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857230001",
"telephone_number": "520-629-6613"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "JON",
"middle_name": "DARREN",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-10-06",
"last_updated": "2015-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MO",
"license": "2011040196",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IL",
"license": "085004141",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "AZ",
"license": "5770",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tucson, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 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.