Kristen Nicole Wilson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.016890 Issued in IL

Practice address

4900 SW 46TH CT Apt 211
Ocala, FL 34474-6264

Phone

(309) 825-8704

NPI assigned

Jul 12, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ultima Rehab-FL LLC

  • Geriatric Physical Therapist
  • North Fort Myers, FL
  • NPI 1053970194
  NPD (past)

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

{
    "created_epoch": "1562889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562889600000",
    "number": "1548812274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4900 SW 46TH CT APT 211",
            "city": "OCALA",
            "state": "FL",
            "postal_code": "344746264",
            "telephone_number": "309-825-8704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4900 SW 46TH CT APT 211",
            "city": "OCALA",
            "state": "FL",
            "postal_code": "344746264",
            "telephone_number": "309-825-8704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "KRISTEN",
        "middle_name": "NICOLE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-07-12",
        "last_updated": "2019-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041S0200X",
            "taxonomy_group": "",
            "desc": "Social Worker, School",
            "state": "IL",
            "license": "2288922",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.016890",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha Willoughby
• Daniel Wills
• Ashley Rose Wilson, LMT
• Emily Doreen Wilson, LCSW
• Jennifer Marie Wilson, MD
• Kristin McGrath Wilson, CRNA
• Levar Antone Wilson, MEDICAL SUPPLY
• Lisa Renee Wilson, LCSW
• Nathan Wilson
• Patricia Kaye Wilson, PHARMD

• Clinical Social Worker in Ocala, FL
• Providers in Ocala, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2019; 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.