Active NPI
Cortney Serene Wilson, SA-C
- Surgical Assistant
- Corydon, IA
National Provider Identifier
1740764661
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Assistant
- License
- 18-332
- Practice address
- 417 S East St
Corydon, IA 50060-1860 - Phone
- (641) 872-2260
- NPI assigned
- Sep 17, 2018
- Last updated
- Sep 17, 2018
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Surgical Assistant | 246ZC0007X | 18-332 | IA | Primary |
Addresses
Primary practice location
417 S East St
Corydon, IA 50060-1860
Mailing address
1405 W South St
Mount Ayr, IA 50854-1267
Phone (641) 234-0657
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18-332 | IA | MD | Surgical Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1537142400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1537142400000",
"number": "1740764661",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1405 W SOUTH ST",
"city": "MOUNT AYR",
"state": "IA",
"postal_code": "508541267",
"telephone_number": "641-234-0657"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "417 S EAST ST",
"city": "CORYDON",
"state": "IA",
"postal_code": "500601860",
"telephone_number": "641-872-2260"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "CORTNEY",
"middle_name": "SERENE",
"credential": "SA-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-09-17",
"last_updated": "2018-09-17",
"status": "A"
},
"taxonomies": [
{
"code": "246ZC0007X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Surgical Assistant",
"state": "IA",
"license": "18-332",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Corydon, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.