Kristin Nicole Wilson, NP-C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

202000961NP-PP Issued in OR

Practice address

2011 4TH St
La Grande, OR 97850-2511

Phone

(541) 963-4139

Fax

(541) 429-6612

NPI assigned

May 12, 2016

Sex

Female

Sole proprietor

No

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 NM

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Lisa Somoza Robles MD LLC

  • Specialist
  • Santa Fe, NM
  • NPI 1770754863
  Medicare reassignment NPD

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

{
    "created_epoch": "1463011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588032000000",
    "number": "1851747596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2011 4TH ST",
            "city": "LA GRANDE",
            "state": "OR",
            "postal_code": "978502511",
            "telephone_number": "541-963-4139",
            "fax_number": "541-429-6612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2011 4TH ST",
            "city": "LA GRANDE",
            "state": "OR",
            "postal_code": "978502511",
            "telephone_number": "541-963-4139",
            "fax_number": "541-429-6612"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2019 Galisteo St",
            "address_2": "Ste A-3",
            "address_purpose": "LOCATION",
            "city": "Santa Fe",
            "state": "NM",
            "postal_code": "875052143",
            "country_code": "US",
            "telephone_number": "505-988-2117",
            "fax_number": "505-988-2119",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "KRISTIN",
        "middle_name": "NICOLE",
        "name_prefix": "Ms.",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-05-12",
        "last_updated": "2020-04-28",
        "certification_date": "2020-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NM",
            "license": "CNP-02899",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OR",
            "license": "202000961NP-PP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William Alfred Pettit III MD
• Cynthia Williams, NP
• Lynette Marie Williamson, CRM, PSS
• Lynn A Willis, NP
• June Marie Wilson, OTL
• Jimmy Wimer
• Karen Wing, MS, CCC-SLP
• Stephanie N Wing, QMHA
• John Winters, N.D.
• Rachelle D Winterton, LMT

• Nurse Practitioner in La Grande, OR
• Providers in La Grande, OR by specialty
• Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2020; 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.