John Tyler Wilson IV, CRNA, PHD

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

072006 Issued in NC

Practice address

Womack Army Medical Center
Fort Bragg, NC 28310-0001

Phone

(910) 907-6286

NPI assigned

Mar 2, 2006

Sex

Male

Sole proprietor

Yes

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

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1141257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490313600000",
    "number": "1508833146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "58 WILLOWCROFT CT",
            "city": "DUNN",
            "state": "NC",
            "postal_code": "283346278",
            "telephone_number": "808-295-6256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "WOMACK ARMY MEDICAL CENTER",
            "city": "FORT BRAGG",
            "state": "NC",
            "postal_code": "283100001",
            "telephone_number": "910-907-6286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JOHN",
        "middle_name": "TYLER",
        "name_prefix": "Dr.",
        "name_suffix": "IV",
        "credential": "CRNA, PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-02",
        "last_updated": "2017-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NC",
            "license": "072006",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wren W Williams, PHARMD
• Yei Zigbuo Williams
• David Bradley Willis, PA-C, MPAS
• Joseph Andrew Willis
• Aliya L Wilson, M.D.
• Ramey Luther Wilson, MD
• Sarah Wilson, PA-C
• Scott Dewaine Wilson
• Jennifer L Wiltz, MD
• Heather Elizabeth Winterbottom, D.O.

• Certified Registered Nurse Anesthetist in Fort Bragg, NC
• Providers in Fort Bragg, NC by specialty
• Certified Registered Nurse Anesthetist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2017; 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.