Nicole Marie Wilson, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

APRN.CNP.0032160 Issued in OH

Practice address

200 Park Ave W
Mansfield, OH 44902-1608

Phone

(419) 522-2239

NPI assigned

Dec 21, 2022

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OH

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

Certified Nurse Practitioner, 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.

• Third Street Community Clinic Inc

  • Federally Qualified Health Center (FQHC)
  • Shelby, OH
  • NPI 1811364706
  Medicare reassignment NPD
• Third Street Community Clinic Inc

  • Federally Qualified Health Center (FQHC)
  • Mansfield, OH
  • NPI 1972053452
  Medicare reassignment NPD
• Third Street Community Clinic, Inc

  • Federally Qualified Health Center (FQHC)
  • Mansfield, OH
  • NPI 1720407554
  Medicare reassignment NPD
• Third Street Community Clinic, Inc.

  • Federally Qualified Health Center (FQHC)
  • Mansfield, OH
  • NPI 1306499314
  Medicare reassignment NPD
• Third Street Community Clinic, Inc.

  • Federally Qualified Health Center (FQHC)
  • Bucyrus, OH
  • NPI 1629620109
  Medicare reassignment NPD
• Third Street Community Clinic, Inc

  • Primary Care Clinic/Center
  • Mansfield, OH
  • NPI 1558576116
  NPD (past)

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

{
    "created_epoch": "1671580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773878400000",
    "number": "1982316949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 PARK AVE W",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449021608",
            "telephone_number": "419-522-2239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 PARK AVE W",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449021608",
            "telephone_number": "419-522-2239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "NICOLE",
        "middle_name": "MARIE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-12-21",
        "last_updated": "2026-03-19",
        "certification_date": "2026-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "APRN.CNP.0032160",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Epic",
            "affiliation": "N",
            "address_1": "200 Park Ave W",
            "city": "Mansfield",
            "state": "OH",
            "country_code": "US",
            "postal_code": "449021608",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Frances Mary Wilson, RD
• Jacoby Wilson
• Jeffrey S Wilson, DPM
• Jonathan Adam Wilson, DDS
• Lauren A. Wilson
• Nyan Win, MD
• Omari Khaleeq Windom
• Walter E Windom Jr.
• Katie Windsor
• Lauren Ashton Winland

• Family Nurse Practitioner in Mansfield, OH
• Providers in Mansfield, OH by specialty
• Family Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2026; 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.