Johnnetta Nicole Wider, RN

Primary specialty

Ambulatory Care Registered NurseTaxonomy code 163WP2201X

License

2911422 Issued in FL

Practice address

5523 Kilcullen LN
Jacksonville, FL 32244-6258

Phone

(904) 672-7820

NPI assigned

Jul 23, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1374537600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374537600000",
    "number": "1710329495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5523 KILCULLEN LN",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322446258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5523 KILCULLEN LN",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322446258",
            "telephone_number": "904-672-7820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIDER",
        "first_name": "JOHNNETTA",
        "middle_name": "NICOLE",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-23",
        "last_updated": "2013-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP2201X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Ambulatory Care",
            "state": "FL",
            "license": "2911422",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Whorton, M.S.
• Whitney Whyte, LPN
• Ethan Wick
• Natavia M Wicker, OTA
• Brian Wickers
• John Widergren
• Kathryn Michelle Widmer
• Victor R Widner, MD
• Jason Brian Widrich, MD
• Christina Stockwell Wieczorek, M.D.

• Ambulatory Care Registered Nurse in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Ambulatory Care Registered Nurse in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2013; 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.