Mindy Smith Wilson, P.A.-C.

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

758 Issued in AL

Practice address

1404 Toney Dr SE
Huntsville, AL 35802-1231

Phone

(859) 608-8890

NPI assigned

Oct 3, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1310083200000",
    "number": "1730273673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1404 TONEY DR SE",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358021231",
            "telephone_number": "859-608-8890",
            "fax_number": "859-608-8890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1404 TONEY DR SE",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358021231",
            "telephone_number": "859-608-8890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "MINDY",
        "middle_name": "SMITH",
        "credential": "P.A.-C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-03",
        "last_updated": "2011-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": "PA996",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "KY",
            "license": "PA996",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AL",
            "license": "758",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE LAB GROUP",
            "identifier": "4000501",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID LAB GROUP",
            "identifier": "37903705",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jacob Wilson, M.D.
• Jennifer Harrelson Wilson, MCD, CCC-SLP
• Kayla Lashawn Wilson, CRNP
• Lori Kim Wilson, LPN
• Michael W Wilson, PH.D
• Miranda Noelle Wilson
• Patricia J Wilson, MD
• Patrick C Wilson, M.D.
• Paul Wilson, D.M.D
• Peter S Wilson, MD

• Medical Physician Assistant in Huntsville, AL
• Providers in Huntsville, AL by specialty
• Medical Physician Assistant in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2011; 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.