Individual provider Active NPI

Autumn Nicole Wilson, APRN

  • Family Nurse Practitioner
  • Poteau, OK
National Provider Identifier
1639874662
Registry record updated Mar 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209703 Issued in OK
Practice address
105 Wall Street
Poteau, OK 74953
Phone
(918) 635-3576
Fax
(918) 635-3332
NPI assigned
Mar 31, 2023
Last updated
Mar 28, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 209703 OK Primary

Addresses

Primary practice location

105 Wall Street
Poteau, OK 74953

Mailing address

105 Wall Street
Poteau, OK 74953
Phone (918) 635-3576

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230420001041 OK Practitioner - Nurse Practitioner 3678938990 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

304 Hwy 59 N
Heavener Medical Clinic
Heavener, OK 74937-2255
Phone (918) 653-2918

PO Box
Suite 689
Poteau, OK 74953

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
209703OKMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Leflore County Hospital Authority Current Accepting new patients
Leflore County Hospital Authority CurrentSince Aug 18, 2024 Accepting new patients
Leflore County Hospital Authority CurrentSince Aug 18, 2024 Accepting new patients
Stigler Health and Wellness Center Inc CurrentSince Mar 20, 2023 Accepting new patients
Leflore County Hospital Authority Past Accepting new patients

Locations

104 Wall St
Poteau, OK 74953
Phone (918) 635-3578

105 Wall St
Poteau, OK 74953
Phone (918) 635-3100

1630 S Kerr Blvd
Sallisaw, OK 74955
Phone (918) 790-2653

1505 E Main St
Stigler, OK 74462
Phone (800) 640-9741

Organizations & group practices 5

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

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1680220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711584000000",
    "number": "1639874662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 WALL STREET",
            "city": "POTEAU",
            "state": "OK",
            "postal_code": "74953",
            "telephone_number": "918-635-3576",
            "fax_number": "918-635-3332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 WALL STREET",
            "city": "POTEAU",
            "state": "OK",
            "postal_code": "74953",
            "telephone_number": "918-635-3576",
            "fax_number": "918-635-3332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "AUTUMN",
        "middle_name": "NICOLE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-31",
        "last_updated": "2024-03-28",
        "certification_date": "2022-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "209703",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Poteau, OK

Sources for this page

Verify at the official NPI Registry.