John William Nielsen, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

101766 Issued in NC

Practice address

1901 S 17TH St
Suite 1
Wilmington, NC 28401-6626

Phone

(910) 343-8424

Fax

(910) 343-6989

NPI assigned

Nov 29, 2005

Sex

Male

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)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Orion Wellness Inc

  • Physician Assistant
  • Wilmington, NC
  • NPI 1689192932
  NPD Authorized official

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

{
    "created_epoch": "1133222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1294704000000",
    "number": "1760465298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 S 17TH ST",
            "address_2": "SUITE 1",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284016626",
            "telephone_number": "910-343-8424",
            "fax_number": "910-343-6989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 S 17TH ST",
            "address_2": "SUITE 1",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284016626",
            "telephone_number": "910-343-8424",
            "fax_number": "910-343-6989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIELSEN",
        "first_name": "JOHN",
        "middle_name": "WILLIAM",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-29",
        "last_updated": "2011-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "101766",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Abby Elizabeth Nicks
• Dennis Bart Nicks, M.D.
• Laura Nicole, LMBT
• Nicole Kay Niedrich, RN BSN IBCLC
• Caitlin Nielsen Davis
• Patricia Deyoung Nielsen, NP
• Tori Nieusma, LCSW
• Lucybeth Nieves-Arriba, MD
• Diana Nilson-Taylor, FNP, C.
• Nina L. Yokochi, DO, PLLC

• Medical Physician Assistant in Wilmington, NC
• Providers in Wilmington, NC by specialty
• Medical Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 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.