Individual provider Active NPI

Andrea Leigh Wilson, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Cottonwood, AZ
National Provider Identifier
1295042331
Registry record updated Apr 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
304737 Issued in AZ
Practice address
8 E Cottonwood St
Cottonwood, AZ 86326-4382
Phone
(877) 634-7333
Fax
(866) 984-3891
NPI assigned
Sep 10, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 304737 AZ Primary

Addresses

Primary practice location

8 E Cottonwood St
Cottonwood, AZ 86326-4382

Mailing address

8 E Cottonwood St
Cottonwood, AZ 86326-4382
Phone (877) 634-7333

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, OR, AZ3 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

Enrollment IDStateProvider typePAC IDDetails
I20220209000191 TX Practitioner - Nurse Practitioner 6406039460 Reassigns benefits to 2 organizations
I20250130001138 OR Practitioner - Nurse Practitioner 6406039460 Reassigns benefits to 1 organization
I20250411003028 AZ Practitioner - Nurse Practitioner 6406039460 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Coquille Indian TribeGroup PAC ID 6002805330, 21 clinicians

Practice addresses (Care Compare)

630 Miluk Dr
Coos Bay, OR 97420-7728

Merit-based Incentive Payment System (MIPS)

Final score
80.86 of 100Reported as group
Quality
61.32
Improvement activities
40
Cost
90.46

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Spectrum Healthcare Group, Inc CurrentSince Mar 17, 2025 Accepting new patients
Spectrum Healthcare Group, Inc Psychiatric/Mental Health CurrentSince Mar 17, 2025 Accepting new patients
Spectrum Healthcare Group, Inc. Psychiatric/Mental Health Current Accepting new patients
Spectrum Healthcare Group, Inc. Family Current Accepting new patients
DHHS PHS Naihs Chinle Comprehensive Health Care Facility Current Accepting new patients
H Lee Moffitt Cancer Ctr & Res Inst Life Time Cancer SCRN Ctr Inc CurrentSince Nov 4, 2019 Accepting new patients
Coquille Indian Tribe CurrentSince Jan 5, 2026 Accepting new patients

Locations

8 E Cottonwood St
Cottonwood, AZ 86326
Phone (928) 203-5404

651 W Mingus Ave
Cottonwood, AZ 86326
Phone (928) 203-5425

8 E Cottonwood St
Bldg A
Cottonwood, AZ 86326
Phone (928) 203-5404

1200 N Country Club Rd
Tucson, AZ 85716
Phone (520) 770-1197

12902 Usf Magnolia Dr
Tampa, FL 33612
Phone (813) 745-2720

630 Miluk Dr
Coos Bay, OR 97420
Phone (541) 756-0904

2401 River Rd
Ste 101
Eugene, OR 97404
Phone (541) 344-8469

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1284076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743552000000",
    "number": "1295042331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 E COTTONWOOD ST",
            "city": "COTTONWOOD",
            "state": "AZ",
            "postal_code": "863264382",
            "telephone_number": "877-634-7333",
            "fax_number": "866-984-3891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8 E COTTONWOOD ST",
            "city": "COTTONWOOD",
            "state": "AZ",
            "postal_code": "863264382",
            "telephone_number": "877-634-7333",
            "fax_number": "866-984-3891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "ANDREA",
        "middle_name": "LEIGH",
        "name_prefix": "Ms.",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-10",
        "last_updated": "2025-04-02",
        "certification_date": "2025-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AZ",
            "license": "304737",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cottonwood, AZ

Sources for this page

Verify at the official NPI Registry.