Amanda Louise Wilson, MD

Primary specialty

Addiction Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0401X

License

60935430 Issued in WA

Practice address

4016 52ND Avenue CT NW
Gig Harbor, WA 98335-7632

Phone

(413) 221-6113

NPI assigned

Mar 14, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• North-Star Care of California PC

  • Addiction Medicine (Internal Medicine) Physician
  • Gig Harbor, WA
  • NPI 1922861145
  NPD Authorized official
• North-Star Care

  • Addiction Medicine (Internal Medicine) Physician
  • Fox Island, WA
  • NPI 1467169581
  NPD

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

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651536000000",
    "number": "1821066085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4016 52ND AVENUE CT NW",
            "city": "GIG HARBOR",
            "state": "WA",
            "postal_code": "983357632",
            "telephone_number": "413-221-6113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4016 52ND AVENUE CT NW",
            "city": "GIG HARBOR",
            "state": "WA",
            "postal_code": "983357632",
            "telephone_number": "413-221-6113"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "82 Main St.",
            "address_purpose": "LOCATION",
            "city": "West Springfield",
            "state": "MA",
            "postal_code": "01089",
            "country_code": "US",
            "telephone_number": "417-788-0100",
            "fax_number": "413-736-1813",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "AMANDA",
        "middle_name": "LOUISE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-14",
        "last_updated": "2022-05-03",
        "certification_date": "2022-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "205246",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "049592",
            "primary": false
        },
        {
            "code": "207RA0401X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": "MI",
            "license": "4301505786",
            "primary": false
        },
        {
            "code": "207RA0401X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": "WA",
            "license": "60935430",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0126748",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003126944",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jamal Williams, ARNP
• Nora Ellen Williams
• Norman D Williams, LMT
• Patrick Williams, LMT
• Kyson Willis
• Lauren Michelle Wilson, DPT
• Ronald Alan Wiltse, RPH
• Johanna Maxine Windisch
• Bethel Grace Wolfe, MS, SUDPT
• Kwang Jong Won, DPT, MS

• Addiction Medicine (Internal Medicine) Physician in Gig Harbor, WA
• Providers in Gig Harbor, WA by specialty
• Addiction Medicine (Internal Medicine) Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2022; 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.