Individual provider Active NPI

Nathan Ashley Wilkinson, AGPCNP-BC

  • Primary Care Nurse Practitioner
  • Hayward, CA
National Provider Identifier
1417515412
Registry record updated Jun 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
95009994 Issued in CA
Practice address
22331 Mission Blvd
Hayward, CA 94541-3911
Phone
(510) 471-5907
NPI assigned
Jun 4, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 95102324 CA
Primary Care Nurse Practitioner 363LP2300X 95009994 CA Primary
Gerontology Nurse Practitioner 363LG0600X 95009994 CA
Adult Health Nurse Practitioner 363LA2200X 95009994 CA

Addresses

Primary practice location

22331 Mission Blvd
Hayward, CA 94541-3911

Mailing address

22331 Mission Blvd
Hayward, CA 94541-3911
Phone (510) 471-5907

Other practice location 1

22331 Mission Blvd
Hayward, CA 94541-3911
Phone (510) 471-5907

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241002001013 CA Practitioner - Nurse Practitioner 2668700105 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95009994CAMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
County of San Mateo CurrentSince Aug 12, 2024 Accepting new patients
County of San Mateo CurrentSince Aug 12, 2024 Accepting new patients

Locations

222 W 39th Ave
San Mateo, CA 94403
Phone (415) 573-2222

Interoperability endpoints

  • Direct secure messaging: nwilkinson20086@smch.direct-ci.com

Organizations & group practices 2

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1559606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559606400000",
    "number": "1417515412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22331 MISSION BLVD",
            "city": "HAYWARD",
            "state": "CA",
            "postal_code": "945413911",
            "telephone_number": "510-471-5907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22331 MISSION BLVD",
            "city": "HAYWARD",
            "state": "CA",
            "postal_code": "945413911",
            "telephone_number": "510-471-5907"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "22331 Mission Blvd",
            "address_purpose": "LOCATION",
            "city": "Hayward",
            "state": "CA",
            "postal_code": "945413911",
            "country_code": "US",
            "telephone_number": "510-471-5907",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILKINSON",
        "first_name": "NATHAN",
        "middle_name": "ASHLEY",
        "credential": "AGPCNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-04",
        "last_updated": "2019-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "95102324",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "CA",
            "license": "95009994",
            "primary": true
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "CA",
            "license": "95009994",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "CA",
            "license": "95009994",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hayward, CA

Sources for this page

Verify at the official NPI Registry.