Tamara Wilson
Individual provider Active NPI Contractor · Portland, TX
NPI 1902228091 · NPPES record last updated Jan 9, 2014
Key facts
- NPI
- 1902228091
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- Practice address
- 1813 Dolphin Dr
Portland, TX 78374-2721 - Phone
- (361) 232-3770
- NPI assigned
- Jan 9, 2014
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | Yes |
Addresses
Primary practice location
1813 Dolphin Dr
Portland, TX 78374-2721
Mailing address
PO Box 220
Portland, TX 78374-0220
Phone (361) 445-4643
NPI Registry JSON
{
"created_epoch": "1389225600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1389225600000",
"number": "1902228091",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 220",
"city": "PORTLAND",
"state": "TX",
"postal_code": "783740220",
"telephone_number": "361-445-4643"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1813 DOLPHIN DR",
"city": "PORTLAND",
"state": "TX",
"postal_code": "783742721",
"telephone_number": "361-232-3770"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "TAMARA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-01-09",
"last_updated": "2014-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 9, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.