Active NPI
Terra Wilde, DNP
- Nurse Practitioner
- Everett, WA
National Provider Identifier
1639699861
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- AP60765620
- Practice address
- 1814 105TH St SE
Everett, WA 98208-4816 - Phone
- (425) 225-3425
- NPI assigned
- Jun 20, 2017
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | AP60765620 | WA | Primary |
Addresses
Primary practice location
1814 105TH St SE
Everett, WA 98208-4816
Mailing address
PO Box 5127
Everett, WA 98206-5127
Phone (425) 339-5453
Other practice location 1
15418 Main St
Mill Creek, WA 98012-9030
Phone (425) 225-8000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2081564 | Medicaid | WA |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1497916800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1662076800000",
"number": "1639699861",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5127",
"city": "EVERETT",
"state": "WA",
"postal_code": "982065127",
"telephone_number": "425-339-5453"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1814 105TH ST SE",
"city": "EVERETT",
"state": "WA",
"postal_code": "982084816",
"telephone_number": "425-225-3425"
}
],
"practiceLocations": [
{
"address_1": "15418 Main St",
"address_purpose": "LOCATION",
"city": "Mill Creek",
"state": "WA",
"postal_code": "980129030",
"country_code": "US",
"telephone_number": "425-225-8000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WILDE",
"first_name": "TERRA",
"credential": "DNP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-06-20",
"last_updated": "2022-09-02",
"certification_date": "2022-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "WA",
"license": "AP60765620",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2081564",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Everett, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.