Sandra Elizabeth Wilson, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

350 Redstone Ave W
Crestview, FL 32536-6433

Phone

(850) 689-1740

Fax

(850) 682-6652

NPI assigned

Jul 23, 2009

Last updated

Jul 23, 2009By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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

{
    "created_epoch": "1248307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1248307200000",
    "number": "1467682435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 WEST REDSTONE AVE",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325360000",
            "telephone_number": "850-689-1740",
            "fax_number": "850-682-6652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 REDSTONE AVE W",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325366433",
            "telephone_number": "850-689-1740",
            "fax_number": "850-682-6652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "SANDRA",
        "middle_name": "ELIZABETH",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-23",
        "last_updated": "2009-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Lance Whorton, PT, MS, MTC
• Kaycee Wilcox, D.M.D
• Zandia Monet Wilkins-Simon, RBT
• Tyisha Wilkins
• Travis T Williams, DPT
• Melissa Winn, LMHC
• Jessica Kristin Wirth, PHARMD
• Womens Manual Physical Therapy LLC (FYZICAL Therapy and Balance Center)
• Jennifer Reshay Wood, PHARMD
• Kyra Wood, OTD

• Medical Physician Assistant in Crestview, FL
• Providers in Crestview, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.