Terry Allen Wilson

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

Practice address

10025 S 705 Rd
Wyandotte, OK 74370-9507

Phone

(918) 303-5433

NPI assigned

Oct 29, 2021

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

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.

• Modoc Nation Behavioral Health

  • Multi-Specialty Clinic/Center
  • Wyandotte, OK
  • NPI 1265083380
  NPD

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

{
    "created_epoch": "1635465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635465600000",
    "number": "1306500905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10025 S 705 RD",
            "city": "WYANDOTTE",
            "state": "OK",
            "postal_code": "743709507",
            "telephone_number": "918-303-5433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10025 S 705 RD",
            "city": "WYANDOTTE",
            "state": "OK",
            "postal_code": "743709507",
            "telephone_number": "918-303-5433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "TERRY",
        "middle_name": "ALLEN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-10-29",
        "last_updated": "2021-10-29",
        "certification_date": "2021-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STUDENT",
            "identifier": "301450",
            "state": "OK"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "terry.wilson@modoclrtc.com",
            "affiliation": "N",
            "endpointDescription": "personal",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "contentOtherDescription": "twilsoneod@gmail.com",
            "address_1": "10025 S 705 Rd",
            "city": "Wyandotte",
            "state": "OK",
            "country_code": "US",
            "postal_code": "743709507",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jamie Dawn Simmons, MSW, LMSW
• Deana Gayle Sweatt, PHARM.D.
• Turkey Ford School
• Samuel Watson
• Vicky Lynn Weidner, M.D.
• Wyandotte Nation
• Wyandotte Nation
• Wyandotte Nation
• Wyandotte School

• All providers in Wyandotte, OK
• Peer Specialist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2021; 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.