Active NPI
Myla Marie Wilson, RN
- Registered Nurse
- Jonesboro, AR
National Provider Identifier
1639397797
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- R069093
- Practice address
- 2707 Browns LN
Jonesboro, AR 72401-7213 - Phone
- (870) 972-4050
- Fax
- (479) 750-4843
- NPI assigned
- Apr 23, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | R069093 | AR | Primary |
Addresses
Primary practice location
2707 Browns LN
Jonesboro, AR 72401-7213
Mailing address
2400 S 48TH St
Springdale, AR 72762-6683
Phone (479) 725-5115
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 173783795 | Medicaid | AR |
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)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R069093 | AR | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177286400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1585008000000",
"number": "1639397797",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2400 S 48TH ST",
"city": "SPRINGDALE",
"state": "AR",
"postal_code": "727626683",
"telephone_number": "479-725-5115",
"fax_number": "479-750-4843"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2707 BROWNS LN",
"city": "JONESBORO",
"state": "AR",
"postal_code": "724017213",
"telephone_number": "870-972-4050",
"fax_number": "479-750-4843"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "MYLA",
"middle_name": "MARIE",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-23",
"last_updated": "2020-03-24",
"certification_date": "2020-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "AR",
"license": "R069093",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "173783795",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jonesboro, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.