Active NPI
Jennifer Bantley Wilson, DO
- Emergency Medicine Physician
- Harrisburg, PA
National Provider Identifier
1336251925
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- OS-005544-L
- Practice address
- 5692 Aberdeen Dr
Harrisburg, PA 17111-4730 - Phone
- (717) 671-0518
- NPI assigned
- Aug 31, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | OS-005544-L | PA | Primary |
Addresses
Primary practice location
5692 Aberdeen Dr
Harrisburg, PA 17111-4730
Mailing address
5692 Aberdeen Dr
Harrisburg, PA 17111-4730
Phone (717) 671-0518
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OS-005544-L | PA | MD | Emergency Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1475107200000",
"number": "1336251925",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5692 ABERDEEN DR",
"city": "HARRISBURG",
"state": "PA",
"postal_code": "171114730",
"telephone_number": "717-671-0518"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5692 ABERDEEN DR",
"city": "HARRISBURG",
"state": "PA",
"postal_code": "171114730",
"telephone_number": "717-671-0518"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "JENNIFER",
"middle_name": "BANTLEY",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-08-31",
"last_updated": "2016-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "PA",
"license": "OS-005544-L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Harrisburg, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2016; 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.