Carmen Dolores Wilson

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

Practice address

433 NE 17TH St Apt 7
McMinnville, OR 97128-3303

Phone

(714) 812-3992

NPI assigned

Sep 9, 2021

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)

Not enrolled

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

{
    "created_epoch": "1631145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658793600000",
    "number": "1639848013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "627 NE EVANS ST",
            "city": "MCMINNVILLE",
            "state": "OR",
            "postal_code": "971283923",
            "telephone_number": "503-434-7523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "433 NE 17TH ST APT 7",
            "city": "MCMINNVILLE",
            "state": "OR",
            "postal_code": "971283303",
            "telephone_number": "714-812-3992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "CARMEN",
        "middle_name": "DOLORES",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-09-09",
        "last_updated": "2022-07-26",
        "certification_date": "2022-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "OR",
            "license": null,
            "primary": true
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaitlyn Willcuts
• Claudia L Williams-Mara, LPC
• John Bruce Williams, MD
• Waverly Tyrese Williams
• Theodore J Williamson, M.D.
• Jason Edward Wilson
• Roxanne Franklin Wilson, BA, QMHA, PSS
• Kayla Renae Winkler, MOT
• J'Deanna Winn, MA
• Nicole Patrice Winnen, R.PH.

• Peer Specialist in McMinnville, OR
• Providers in McMinnville, OR by specialty
• Peer Specialist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 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.

Verify at the official NPI Registry.