Melissa Louise Wilson, FAMILY NURSE PRACTIT

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

201350121NP Issued in OR

Practice address

524 Spruce Street Unit 3
Brookings, OR 97415

Phone

(541) 412-3726

Fax

(541) 412-3729

NPI assigned

Oct 6, 2005

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1128556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466035200000",
    "number": "1700873528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15438 SOUTHWIND LANE",
            "city": "BROOKINGS",
            "state": "OR",
            "postal_code": "97415",
            "telephone_number": "541-412-3726",
            "fax_number": "541-412-3729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "524 SPRUCE STREET UNIT 3",
            "city": "BROOKINGS",
            "state": "OR",
            "postal_code": "97415",
            "telephone_number": "541-412-3726",
            "fax_number": "541-412-3729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "MELISSA",
        "middle_name": "LOUISE",
        "name_prefix": "Ms.",
        "credential": "FAMILY NURSE PRACTIT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-10-06",
        "last_updated": "2016-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "N32717",
            "primary": false
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "ID",
            "license": "N32717",
            "primary": false
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "201350121NP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806760300",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9639428",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katrina Jeannine West, QMHP
• Wild Rivers Physiatry, Inc
• Karen Stella Williams, C.O.T.A.
• Ronald B Williams, RPH
• Krista Nichole Wilson
• Jackie Wiseman
• Nancy Wolf, FNP
• Kim I Wolter, MSN, RN, CHPN, PHN
• Barbara Lynn Woodcock, P.T.A.
• Lacy Ann Woods, OTR/L

• Family Nurse Practitioner in Brookings, OR
• Providers in Brookings, OR by specialty
• Family Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2016; 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.