Kyler Edward Wilson

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

116037742 Issued in VA

Practice address

3650 Joseph Siewick Dr
Fairfax, VA 22033-1710

Phone

(703) 391-2020

NPI assigned

Jun 15, 2023

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

Enrolled in DC, VA2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

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.

• Frederick Health Hospital Inc

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)

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

{
    "created_epoch": "1686787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686787200000",
    "number": "1881379170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3650 JOSEPH SIEWICK DR",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220331710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3650 JOSEPH SIEWICK DR",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220331710",
            "telephone_number": "703-391-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "KYLER",
        "middle_name": "EDWARD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-15",
        "last_updated": "2023-06-15",
        "certification_date": "2023-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "116037742",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Wilson
• Emma Wilson
• Kaitlin Patricia Wilson, MS OTR/L
• Kanisha Wilson, LPC
• Kelsey Nichole Wilson, LCSW
• Mazzie Wilson
• Melodi Lynette Wilson, M.D.
• Paulina G Wilson, M.D.
• Samantha Wilson
• Sherri Wilson, RN

• Family Medicine Physician in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Family Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2023; 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.