Amanda Marie Wilson, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP10995 Issued in AZ

Practice address

1151 W Iron Springs Rd Ste F
Prescott, AZ 86305-1614

Phone

(928) 445-8160

NPI assigned

Feb 12, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Mandy Marie Wilson Other name

Medicare fee-for-service enrollment

Enrolled in AZ

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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.

• The Little Clinic of Arizona LLC

  • Family Nurse Practitioner
  • Buckeye, AZ
  • NPI 1023216249
  Medicare reassignment NPD

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

{
    "created_epoch": "1518393600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1518393600000",
    "number": "1316447774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5980 S MORNING STAR LN",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863038668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1151 W IRON SPRINGS RD STE F",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863051614",
            "telephone_number": "928-445-8160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "AMANDA",
        "middle_name": "MARIE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-12",
        "last_updated": "2018-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "AP10995",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MANDY",
            "last_name": "WILSON",
            "middle_name": "MARIE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Valerie Williams, OTR/L
• Williamson Valley Fire District
• Willow Integration LLC
• Willow Wind Assisted Living LLC
• Thomas Wills
• Emilie Clasgens Wilson, ND
• Hope Elizabeth Wilson, MPH, RDN
• Lawrence Wilson
• Raequi Wilson, N.D.
• Robin Wilson

• Family Nurse Practitioner in Prescott, AZ
• Providers in Prescott, AZ by specialty
• Family Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.