Raquel Shelly Solivan Wilson, IDMT

Primary specialty

Independent Duty Medical TechniciansTaxonomy code 1710I1003X

Practice address

23 Medical Group/SGPF 3278 Mitchell Blvd BLD 900
Moody AFB, GA 31699-8273

Phone

(229) 257-4685

Fax

(229) 257-3242

NPI assigned

Jun 23, 2010

Last updated

Nov 8, 2023By 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)

Not enrolled

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

{
    "created_epoch": "1277251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699401600000",
    "number": "1528379732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23 MEDICAL GROUP/SGPF 3278 MITCHELL BLVD BLDG 900",
            "city": "MOODY AFB",
            "state": "GA",
            "postal_code": "316990001",
            "telephone_number": "229-257-4685",
            "fax_number": "229-257-3242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 MEDICAL GROUP/SGPF 3278 MITCHELL BLVD BLD 900",
            "city": "MOODY AFB",
            "state": "GA",
            "postal_code": "316998273",
            "telephone_number": "229-257-4685",
            "fax_number": "229-257-3242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOLIVAN WILSON",
        "first_name": "RAQUEL",
        "middle_name": "SHELLY",
        "credential": "IDMT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-23",
        "last_updated": "2023-11-08",
        "certification_date": "2023-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1003X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Medical Technicians",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Debra Sizemore, MS, WHNP-BC, RNC-OB
• Charnell E Smith-Akpassa
• Allison Smith, PHARMD
• Rachel Smith, ATC, LAT, M.ED.
• Glen Snyder, IDMT
• Katie Stauffer, ATC
• Collin M Stevens
• Sarah E Stone, APRN-CNP
• Corey J Strickland
• Yanisa Alexandra Stuart Salas

• Independent Duty Medical Technicians in Moody AFB, GA
• Providers in Moody AFB, GA by specialty
• Independent Duty Medical Technicians in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2023; 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.