Active NPI
Carolynn E Wilson, RN
- Child & Adolescent Psychiatric/Mental Health Registered Nurse
- Holland, MI
National Provider Identifier
1366792590
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Child & Adolescent Psychiatric/Mental Health Registered Nurse
- License
- 4704165529
- Practice address
- 12263 James St
Holland, MI 49424-8613 - Phone
- (616) 494-5698
- NPI assigned
- Sep 14, 2012
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Child & Adolescent Psychiatric/Mental Health Registered Nurse | 163WP0807X | 4704165529 | MI | Primary |
Addresses
Primary practice location
12263 James St
Holland, MI 49424-8613
Mailing address
12263 James St
Holland, MI 49424-8613
Phone (616) 494-5698
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704165529 | MI | MD | Child & Adolescent Psychiatric/Mental Health Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1347580800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1347580800000",
"number": "1366792590",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12263 JAMES ST",
"city": "HOLLAND",
"state": "MI",
"postal_code": "494248613",
"telephone_number": "616-494-5698"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12263 JAMES ST",
"city": "HOLLAND",
"state": "MI",
"postal_code": "494248613",
"telephone_number": "616-494-5698"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "CAROLYNN",
"middle_name": "E",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-09-14",
"last_updated": "2012-09-14",
"status": "A"
},
"taxonomies": [
{
"code": "163WP0807X",
"taxonomy_group": "",
"desc": "Registered Nurse, Psychiatric/Mental Health, Child & Adolescent",
"state": "MI",
"license": "4704165529",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Holland, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.