Individual provider Active NPI

Leah Marie Wilson, N.P.

  • Nurse Practitioner
  • Orange, CA
National Provider Identifier
1447435144
Registry record updated Feb 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
12645 Issued in CA
Practice address
230 S Main St
Suite 100
Orange, CA 92868-3851
Phone
(714) 541-0101
Fax
(714) 541-0450
NPI assigned
Jan 1, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 12645 CA Primary

Addresses

Primary practice location

230 S Main St
Suite 100
Orange, CA 92868-3851

Mailing address

11529 La Cantera TRL
Frisco, TX 75033-1448
Phone (631) 708-7624

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20170313001060 TX Practitioner - Nurse Practitioner 1759665730 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Healthtexas Provider NetworkGroup PAC ID 1355254210, 2,535 clinicians

Practice addresses (Care Compare)

4700 Alliance Blvd
Plano, TX 75093-5323
Phone (214) 820-9895

Hospital & facility affiliations

  • Baylor Scott & White Medical Center Plano Hospital, Plano, TX, CCN 450890

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
12645CAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Healthtexas Provider Network CurrentSince Apr 15, 2024 Accepting new patients
Healthtexas Provider Network Current Accepting new patients
Healthtexas Provider Network CurrentSince Apr 15, 2024 Accepting new patients
Healthtexas Provider Network Past Accepting new patients

Locations

301 N Washington Ave
Dallas, TX 75246
Phone (469) 800-8330

4700 Dexter Dr
Ste 400
Plano, TX 75093
Phone (469) 209-8100

4700 Alliance Blvd
Plano, TX 75093
Phone (469) 814-2000

821 N Coleman St
Ste 100
Prosper, TX 75078
Phone (469) 800-5200

Interoperability endpoints

  • Direct secure messaging: lwilson461156@direct.sw.org

Organizations & group practices 4

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1199145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392854400000",
    "number": "1447435144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11529 LA CANTERA TRL",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750331448",
            "telephone_number": "631-708-7624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 S MAIN ST",
            "address_2": "SUITE 100",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928683851",
            "telephone_number": "714-541-0101",
            "fax_number": "714-541-0450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "LEAH",
        "middle_name": "MARIE",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-01",
        "last_updated": "2014-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "12645",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange, CA

Sources for this page

Verify at the official NPI Registry.