Active NPI
Hettie Tabitha Wilson, PA
- Physician Assistant
- Germantown, MD
National Provider Identifier
1467512608
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA0365
- Practice address
- 20010 Century Blvd
Suite 200
Germantown, MD 20874-1115 - Phone
- (240) 686-2300
- NPI assigned
- Dec 11, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA0365 | TX | Primary |
Addresses
Primary practice location
20010 Century Blvd
Suite 200
Germantown, MD 20874-1115
Mailing address
20010 Century Blvd
Suite 200
Germantown, MD 20874-1115
Phone (240) 686-2300
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8Y8829 | Other | TX | BCBSTX |
| 8N4694 | Other | TX | BLUE CROSS BLUE SHIELD |
| P00227237 | Other | TX | RAILROAD MEDICARE |
| 182578802 | Medicaid | TX |
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
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA0365 | TX | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165795200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1381449600000",
"number": "1467512608",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20010 CENTURY BLVD",
"address_2": "SUITE 200",
"city": "GERMANTOWN",
"state": "MD",
"postal_code": "208741115",
"telephone_number": "240-686-2300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20010 CENTURY BLVD",
"address_2": "SUITE 200",
"city": "GERMANTOWN",
"state": "MD",
"postal_code": "208741115",
"telephone_number": "240-686-2300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "HETTIE",
"middle_name": "TABITHA",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-11",
"last_updated": "2013-10-11",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TX",
"license": "PA0365",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSTX",
"identifier": "8Y8829",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "8N4694",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00227237",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "182578802",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Germantown, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.