Active NPI
Sharon J. Wilson, ARNP
- Family Nurse Practitioner
- Everett, WA
National Provider Identifier
1407874548
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- AP30006683
- Practice address
- 930 N Broadway
Everett, WA 98201-1585 - Phone
- (425) 317-0300
- NPI assigned
- Jul 17, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN00151982 | WA | |
| Family Nurse Practitioner | 363LF0000X | AP30006683 | WA | Primary |
Addresses
Primary practice location
930 N Broadway
Everett, WA 98201-1585
Mailing address
PO Box 3360
Portland, OR 97208-3360
Phone (866) 366-2983
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 42918U | Other | WA | REGENCE BLUESHIELD |
| 0195595 | Other | WA | LABOR & INDUSTRY |
| 9643073 | Medicaid | WA |
Other names 1
- Sharon J. Custard
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
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN00151982 | WA | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1429228800000",
"number": "1407874548",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3360",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972083360",
"telephone_number": "866-366-2983"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "930 N BROADWAY",
"city": "EVERETT",
"state": "WA",
"postal_code": "982011585",
"telephone_number": "425-317-0300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "SHARON",
"middle_name": "J.",
"credential": "ARNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-17",
"last_updated": "2015-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "WA",
"license": "RN00151982",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "WA",
"license": "AP30006683",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUESHIELD",
"identifier": "42918U",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LABOR & INDUSTRY",
"identifier": "0195595",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9643073",
"state": "WA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "SHARON",
"last_name": "CUSTARD",
"middle_name": "J.",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Everett, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.