Lisa Nicole Wilson, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

F312374-01 Issued in NY

Practice address

640 Belle Terre Rd
Port Jefferson, NY 11777-1936

Phone

(631) 828-5361

NPI assigned

Jul 24, 2025

Sex

Female

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1753315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753315200000",
    "number": "1942182472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "195 N UTICA AVE",
            "city": "NORTH MASSAPEQUA",
            "state": "NY",
            "postal_code": "117582143",
            "telephone_number": "347-423-1784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 BELLE TERRE RD",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117771936",
            "telephone_number": "631-828-5361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "LISA",
        "middle_name": "NICOLE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-07-24",
        "last_updated": "2025-07-24",
        "certification_date": "2025-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NY",
            "license": "F312374-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ian Ralph Whiteside, M.D.
• Barbara J Wickenhauser
• Michelle K Wiley
• Robert G Williams, DDS
• Paul Dana Willms, FNP-C
• Robert Steven Wilutis, MS OTR CHT
• Deborah A Winslow, N.P.
• Florence Mary Wissert, NPP,FNP,CARN,CS
• John Joseph Woehrle, RPA-C
• Raymond Wong

• Nurse Practitioner in Port Jefferson, NY
• Providers in Port Jefferson, NY by specialty
• Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2025; 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.