Active NPI
Sandra Kay Wilson, CSFA
- Surgery Physician
- Tyler, TX
National Provider Identifier
1972249811
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 205120
- Practice address
- 800 E Dawson St
Tyler, TX 75701-2036 - Phone
- (903) 531-8441
- NPI assigned
- May 12, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 205120 | TX | Primary |
Addresses
Primary practice location
800 E Dawson St
Tyler, TX 75701-2036
Mailing address
1635 County Road 313 W
Tyler, TX 75706-2813
Phone (903) 920-3984
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 205120 | TX | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1652313600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1652313600000",
"number": "1972249811",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1635 COUNTY ROAD 313 W",
"city": "TYLER",
"state": "TX",
"postal_code": "757062813",
"telephone_number": "903-920-3984"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 E DAWSON ST",
"city": "TYLER",
"state": "TX",
"postal_code": "757012036",
"telephone_number": "903-531-8441"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "SANDRA",
"middle_name": "KAY",
"credential": "CSFA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-05-12",
"last_updated": "2022-05-12",
"certification_date": "2022-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "TX",
"license": "205120",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 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.