Active NPI
Kenneth Monroe Wilson, MHO PT SCS ATC
- Physical Therapist
- Farmington, MO
National Provider Identifier
1396854915
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 02273
- Practice address
- 1355 Maple Street
Farmington, MO 63640 - Phone
- (573) 756-9900
- Fax
- (573) 756-9988
- NPI assigned
- Aug 29, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 02273 | MO | Primary |
Addresses
Primary practice location
1355 Maple Street
Farmington, MO 63640
Mailing address
730 Joachim St
Festus, MO 63028-1414
Phone (636) 208-8163
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
Interoperability endpoints
- kenny.wilson.p2@direct.athleticoltd.nextgenshare.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1200960000000",
"number": "1396854915",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "730 JOACHIM ST",
"city": "FESTUS",
"state": "MO",
"postal_code": "630281414",
"telephone_number": "636-208-8163"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1355 MAPLE STREET",
"city": "FARMINGTON",
"state": "MO",
"postal_code": "63640",
"telephone_number": "573-756-9900",
"fax_number": "573-756-9988"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "KENNETH",
"middle_name": "MONROE",
"credential": "MHO PT SCS ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-29",
"last_updated": "2008-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MO",
"license": "02273",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Farmington, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.