Active NPI
Stephanie Ivy Wilson
- Dentist
- Conroe, TX
National Provider Identifier
1396031654
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 27056
- Practice address
- 3091 College Park Dr
Suite #125
Conroe, TX 77384-8023 - Phone
- (832) 326-3286
- NPI assigned
- Jun 24, 2011
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 27056 | TX | Primary |
Addresses
Primary practice location
3091 College Park Dr
Suite #125
Conroe, TX 77384-8023
Mailing address
3091 College Park Dr
Suite #125
Conroe, TX 77384-8023
Phone (832) 326-3286
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 27056 | TX | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Paul Children's Medical Corporation | Past | Accepting new patients |
Organizations & group practices 1
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.
-
dba Bethesda Pediatrics
- Pediatric Dentistry
- Tyler, TX
- NPI 1467689307
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1308873600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1314835200000",
"number": "1396031654",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3091 COLLEGE PARK DR",
"address_2": "SUITE #125",
"city": "CONROE",
"state": "TX",
"postal_code": "773848023",
"telephone_number": "832-326-3286"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3091 COLLEGE PARK DR",
"address_2": "SUITE #125",
"city": "CONROE",
"state": "TX",
"postal_code": "773848023",
"telephone_number": "832-326-3286"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "STEPHANIE",
"middle_name": "IVY",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-06-24",
"last_updated": "2011-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "27056",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Conroe, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.