Active NPI
Jennifer Michelle Wilson, PA-C
- Medical Physician Assistant
- Tucson, AZ
National Provider Identifier
1508151606
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 5385
- Practice address
- 1760 E River Rd
Ste. # 350
Tucson, AZ 85718-5877 - Phone
- (520) 519-7775
- NPI assigned
- Jun 16, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | PA-091 | NM | |
| Medical Physician Assistant | 363AM0700X | 5385 | AZ | Primary |
Addresses
Primary practice location
1760 E River Rd
Ste. # 350
Tucson, AZ 85718-5877
Mailing address
6320 W Union Hills Dr
Ste B - 1600
Glendale, AZ 85308-1096
Phone (602) 357-2400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 661364 | Medicaid | AZ |
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 |
|---|---|---|---|
| 5385 | AZ | MD | Occupational Therapy Assistant |
| PA-091 | NM | MD | Surgical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1308182400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1391126400000",
"number": "1508151606",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6320 W UNION HILLS DR",
"address_2": "STE B - 1600",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853081096",
"telephone_number": "602-357-2400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1760 E RIVER RD",
"address_2": "STE. # 350",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857185877",
"telephone_number": "520-519-7775"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "JENNIFER",
"middle_name": "MICHELLE",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-06-16",
"last_updated": "2014-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "NM",
"license": "PA-091",
"primary": false
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "AZ",
"license": "5385",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "661364",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tucson, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.