Jerell James Wilson, D.D.S

Primary specialty

DentistTaxonomy code 122300000X

License

2012015521 Issued in MO

Practice address

316 Maine St
Lawrence, KS 66044-1359

Phone

(785) 312-7770

Fax

(785) 312-9447

NPI assigned

May 31, 2012

Sex

Male

Sole proprietor

Yes

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

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1338422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1404086400000",
    "number": "1770844359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1811 ZUMBEHL RD",
            "city": "SAINT CHARLES",
            "state": "MO",
            "postal_code": "633032728",
            "telephone_number": "636-947-1800",
            "fax_number": "636-916-0114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "316 MAINE ST",
            "city": "LAWRENCE",
            "state": "KS",
            "postal_code": "660441359",
            "telephone_number": "785-312-7770",
            "fax_number": "785-312-9447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JERELL",
        "middle_name": "JAMES",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-05-31",
        "last_updated": "2014-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2012015521",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hillary Willson, LAT, ATC
• Aaron R Wilmes, O.D.
• Angela N. Wilson, DDS MS
• Bailey Wilson
• Danielle Wilson, LPC
• Kaci Wilson
• Megan Wilson, LPC
• Sarah Wilson
• Lori Lynn Winfrey
• Maureen Martin Winkler, APRN,

• Dentist in Lawrence, KS
• Providers in Lawrence, KS by specialty
• Dentist in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.