NPIMap

Individual provider Active NPI

Tiffany Kay Wilson, P.A.

  • Physician Assistant
  • Henrietta, TX
National Provider Identifier
1710920178
Registry record updated May 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA04018 Issued in TX
Practice address
412 W South St
Henrietta, TX 76365-3348
Phone
(940) 235-3403
Fax
(580) 272-0186
NPI assigned
Jun 14, 2006
Last updated
May 19, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 19, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2381 OK
Physician Assistant 363A00000X PA04018 TX Primary

Addresses

Primary practice location

412 W South St
Henrietta, TX 76365-3348

Mailing address

412 W South St
Henrietta, TX 76365-3348
Phone (940) 235-3403

Other identifiers 1

IdentifierTypeStateIssuer
185065301MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, OK2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20050120000904 TX Practitioner - Physician Assistant 0941284582 Reassigns benefits to 2 organizations
I20140806000919 OK Practitioner - Physician Assistant 0941284582 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Preferred Hospital Leasing Shamrock IncGroup PAC ID 9739577578, shared by 3 NPIs, 4 clinicians

Practice addresses (Care Compare)

1000 S Main St
Shamrock, TX 79079-2820
Phone (806) 256-2114

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
United Regional Health Care System Inc Current Accepting new patients
Preferred Hospital Leasing Shamrock, Inc. CurrentSince Jul 1, 2025 Accepting new patients
Preferred Hospital Leasing Shamrock, Inc. CurrentSince Apr 19, 2025 Accepting new patients
Summit Medical Center Past Accepting new patients
Preferred Hospital Leasing Inc Physician Assistant Past Accepting new patients
Preferred Hospital Leasing Inc. Past Accepting new patients
South Wheeler County Hospital District Past Accepting new patients

Locations

1000 S Main St
Shamrock, TX 79079
Phone (806) 256-2114

1010 S Main St
Shamrock, TX 79079
Phone (806) 256-5148

Interoperability endpoints

  • FHIR API: https://epicproxy.et1096.epichosted.com/FHIRProxy/api/FHIR/DSTU2/
  • FHIR API: https://epicproxy.et1096.epichosted.com/FHIRProxy/api/fhir/r4/
  • Direct secure messaging: twilson15021@unitedregional.medalliesdirect.net

Organizations & group practices 8

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 8

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": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621382400000",
    "number": "1710920178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "412 W SOUTH ST",
            "city": "HENRIETTA",
            "state": "TX",
            "postal_code": "763653348",
            "telephone_number": "940-235-3403",
            "fax_number": "580-272-0186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "412 W SOUTH ST",
            "city": "HENRIETTA",
            "state": "TX",
            "postal_code": "763653348",
            "telephone_number": "940-235-3403",
            "fax_number": "580-272-0186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "TIFFANY",
        "middle_name": "KAY",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-14",
        "last_updated": "2021-05-19",
        "certification_date": "2021-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "2381",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA04018",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "185065301",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Henrietta, TX

Sources for this page

Verify at the official NPI Registry.