Dominique Renee Wilson, DNP, PMHNP, FNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

202100794NP Issued in OR

Practice address

205 SE Spokane St Ste 300
Portland, OR 97202-6487

Phone

(855) 704-2004

Fax

(503) 386-3366

NPI assigned

Sep 30, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Enrolled in TX, OR, WA3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 3

Specialty

Nurse Practitioner

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: reliefmentalhealth.dominiquewilson@152381.advancedmd-direct.com

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.

• Relief Mental Health Consultants PLLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Portland, OR
  • NPI 1538784004
  Medicare reassignment Authorized official
• Adult Child & Adolescent Psychiatric Services PA

  • Psychiatry Physician
  • Plano, TX
  • NPI 1194036459
  Medicare reassignment NPD
• DFW Psychiatry Associates PA

  • Psychiatry Physician
  • Frisco, TX
  • NPI 1932539210
  Medicare reassignment NPD
• Hawkins Psychiatry PC

  • Psychiatry Physician
  • Arlington, TX
  • NPI 1003056607
  Medicare reassignment
• Mindful Therapy Group PC

  • Clinical Social Worker
  • Mountlake Terrace, WA
  • NPI 1316238678
  Medicare reassignment
• Hope Starts Here LLC

  • Psychiatry Physician
  • Arlington, TX
  • NPI 1053185983
  NPD (past)
• Nisha Satish MD PA

  • Family Medicine Physician
  • Greenville, TX
  • NPI 1902171226
  NPD (past)

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

{
    "created_epoch": "1317340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714521600000",
    "number": "1295019909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 SE SPOKANE ST STE 300",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972026487",
            "telephone_number": "855-704-2004",
            "fax_number": "503-386-3366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 SE SPOKANE ST STE 300",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972026487",
            "telephone_number": "855-704-2004",
            "fax_number": "503-386-3366"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "401 Broadway Ste 100",
            "address_purpose": "LOCATION",
            "city": "Tacoma",
            "state": "WA",
            "postal_code": "984023900",
            "country_code": "US",
            "telephone_number": "855-704-2004",
            "fax_number": "503-386-3366",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2000 E LaMar Blvd Ste 600",
            "address_purpose": "LOCATION",
            "city": "Arlington",
            "state": "TX",
            "postal_code": "760067361",
            "country_code": "US",
            "telephone_number": "855-704-2004",
            "fax_number": "503-386-3366",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "DOMINIQUE",
        "middle_name": "RENEE",
        "name_prefix": "Ms.",
        "credential": "DNP, PMHNP, FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-30",
        "last_updated": "2024-05-01",
        "certification_date": "2024-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP119115",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP61131624",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "202100794NPPP",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "AP119115",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OR",
            "license": "202100794NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Jean Wilson, MD
• Davonna Wilson, DNP, ARNP, PMHNP-BC
• Deanna Marie Wilson, LMT LICENSE #13180
• Deborah Lee Wilson, PMHNP
• Deonte Mikel Wilson
• Eric Wilson
• Erika Helen Wilson, D.O.
• Erin Elizabeth Wilson
• Eva Wilson
• Gail Renee Wilson

• Psychiatric/Mental Health Nurse Practitioner in Portland, OR
• Providers in Portland, OR by specialty
• Psychiatric/Mental Health Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.