Active NPI
Larry Flick Wilson, MD
- Aerospace Medicine Physician
- Kansas City, MO
National Provider Identifier
1689749582
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Aerospace Medicine Physician
- License
- 12735
- Practice address
- Faa, Ace-300
901 Locust Street, RM 350
Kansas City, MO 64106 - Phone
- (816) 329-3250
- NPI assigned
- Nov 24, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Aerospace Medicine Physician | 2083A0100X | 12735 | NE | Primary |
Addresses
Primary practice location
Faa, Ace-300
901 Locust Street, RM 350
Kansas City, MO 64106
Mailing address
180 Rockbridge Parkway
Excelsior Springs, MO 64024
Phone (816) 630-0771
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
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12735 | NE | MD | Ambulatory Care Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164326400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1689749582",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "180 ROCKBRIDGE PARKWAY",
"city": "EXCELSIOR SPRINGS",
"state": "MO",
"postal_code": "64024",
"telephone_number": "816-630-0771"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "FAA, ACE-300",
"address_2": "901 LOCUST STREET, RM 350",
"city": "KANSAS CITY",
"state": "MO",
"postal_code": "64106",
"telephone_number": "816-329-3250"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "LARRY",
"middle_name": "FLICK",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2083A0100X",
"taxonomy_group": "",
"desc": "Preventive Medicine, Aerospace Medicine",
"state": "NE",
"license": "12735",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kansas City, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.