Audra Anne Wilson, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA-834 Issued in AR

Practice address

4100 Outpatient Circle
Little Rock, AR 72205-7101

Phone

(501) 686-6765

Fax

(501) 686-5609

NPI assigned

Jan 31, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Audra Anne Nosal Former name

Medicare fee-for-service enrollment

Enrolled in AR

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• University of Arkansas for Medical Sciences

  • Internal Medicine Physician
  • Little Rock, AR
  • NPI 1588654016
  Medicare reassignment
• University of Arkansas for Medical Sciences

  • Family Medicine Physician
  • El Dorado, AR
  • NPI 1023795051
  NPD

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

{
    "created_epoch": "1548892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716163200000",
    "number": "1457815755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4301 W MARKHAM ST # 783",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722057101",
            "telephone_number": "501-686-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 OUTPATIENT CIRCLE",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722057101",
            "telephone_number": "501-686-6765",
            "fax_number": "501-686-5609"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1308 E Kiehl Ave",
            "address_purpose": "LOCATION",
            "city": "Sherwood",
            "state": "AR",
            "postal_code": "721203040",
            "country_code": "US",
            "telephone_number": "501-835-0703",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "AUDRA",
        "middle_name": "ANNE",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-31",
        "last_updated": "2024-05-20",
        "certification_date": "2024-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AR",
            "license": "PA-834",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AUDRA",
            "last_name": "NOSAL",
            "middle_name": "ANNE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Amy Marie Wilson, APN
• Anna Marie Wilson, RBT
• Ashley Wilson
• Ashley Wilson, CPNP-PC
• Aubrey Wilson
• Barbara Jean Wilson, OTR
• Brett Lonnis Wilson, LPC
• Caressa Corine Wilson, PT, DPT
• Cherrelle L Wilson, MHPP
• Cheyenne Wilson

• Medical Physician Assistant in Little Rock, AR
• Providers in Little Rock, AR by specialty
• Medical Physician Assistant in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.