Individual provider Active NPI

Robert Eugene Wilson, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Johnson City, TN
National Provider Identifier
1437908308
Registry record updated Jul 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
33192 Issued in TN
Practice address
203 Gray Commons Cir Ste 110
Johnson City, TN 37615-5406
Phone
(833) 371-0509
NPI assigned
May 14, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2026

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 192586 TN
Social Worker 104100000X 7898 TN
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 33192 TN Primary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 0024186778 VA

Addresses

Primary practice location

203 Gray Commons Cir Ste 110
Johnson City, TN 37615-5406

Mailing address

203 Gray Commons Cir Ste 110
Johnson City, TN 37615-5406
Phone (833) 371-0509

Other practice location 1

3101 Lee Highway
Bristol, VA 24201-5944
Phone (276) 967-6000

Other practice location 2

5511 Virginia Way Ste 300
Brentwood, TN 37027-7611
Phone (615) 994-1000

Other practice location 3

249 Central Park Ave Ste 300-161
Virginia Beach, VA 23462-3099
Phone (757) 785-0500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
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.

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

5511 Virginia Way
Suite 300
Brentwood, TN 37027-7611

825 Walnut St
Elizabethton, TN 37643-2063

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
33192TNMDPsychiatric/Mental Health Nurse Practitioner
0024186778VAMDPsychiatric/Mental Health Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1715644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783641600000",
    "number": "1437908308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 GRAY COMMONS CIR STE 110",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376155406",
            "telephone_number": "833-371-0509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 GRAY COMMONS CIR STE 110",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376155406",
            "telephone_number": "833-371-0509"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3101 Lee Highway",
            "address_purpose": "LOCATION",
            "city": "Bristol",
            "state": "VA",
            "postal_code": "242015944",
            "country_code": "US",
            "telephone_number": "276-967-6000",
            "fax_number": "615-994-0100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5511 Virginia Way Ste 300",
            "address_purpose": "LOCATION",
            "city": "Brentwood",
            "state": "TN",
            "postal_code": "370277611",
            "country_code": "US",
            "telephone_number": "615-994-1000",
            "fax_number": "615-994-0100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "249 Central Park Ave Ste 300-161",
            "address_purpose": "LOCATION",
            "city": "Virginia Beach",
            "state": "VA",
            "postal_code": "234623099",
            "country_code": "US",
            "telephone_number": "757-785-0500",
            "fax_number": "757-785-0500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "ROBERT",
        "middle_name": "EUGENE",
        "name_prefix": "Mr.",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-05-14",
        "last_updated": "2026-07-10",
        "certification_date": "2026-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TN",
            "license": "192586",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "TN",
            "license": "7898",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TN",
            "license": "33192",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "VA",
            "license": "0024186778",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, TN

Sources for this page

Verify at the official NPI Registry.