Nicole Joann Wilson, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

62339 Issued in MN

Practice address

9680 Tamarack Rd Ste 100
Woodbury, MN 55125-2617

Phone

(651) 738-9001

Fax

(651) 738-8915

NPI assigned

Apr 25, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Central Pediatrics, P.a.

  • Primary Care Clinic/Center
  • Woodbury, MN
  • NPI 1396721387
  NPD (past)
• Pediatric Surgical Associates LTD

  • Pediatric Surgery Physician
  • Minneapolis, MN
  • NPI 1093778292

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1398384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1770903015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9680 TAMARACK RD STE 100",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551252617",
            "telephone_number": "651-738-9001",
            "fax_number": "651-738-8915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9680 TAMARACK RD STE 100",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551252617",
            "telephone_number": "651-738-9001",
            "fax_number": "651-738-8915"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2450 Riverside Ave",
            "address_2": "6th Floor, East Building",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554541450",
            "country_code": "US",
            "telephone_number": "612-624-4418",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "NICOLE",
        "middle_name": "JOANN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-04-25",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "62339",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeanne Williamson
• Steven Stenberg Williamson, PAC
• Adrian Wilson
• David James Wilson, DC
• Kent Shannon Wilson, MD
• Rebekah Joy Wilson, PA
• Sheena Wilson
• Winston Behavioral Healthcare
• Teresa L Winston, MA
• Mallory Wirth

• Pediatrics Physician in Woodbury, MN
• Providers in Woodbury, MN by specialty
• Pediatrics Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.