Gavin Keith Wilson, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9102199 Issued in FL

Practice address

1800 SE Tiffany Ave
Port St Lucie, FL 34952-7521

Phone

(772) 398-3800

NPI assigned

Jun 5, 2006

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 FL

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

Doctor of Osteopathy, Doctor of Medicine, Physician Assistant

Practice roles

Interoperability endpoints

• Direct secure messaging: gavin.wilson.1@25843.direct.athenahealth.com

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.

• Paragon Contracting Services LLC

  • Emergency Medicine Physician
  • Birmingham, AL
  • NPI 1225071459

  FL

  Medicare reassignment
• Emcare Physician Providers, Inc.

  • Emergency Medicine Physician
  • Punta Gorda, FL
  • NPI 1376592063
  NPD (past)
• Hillmoor ER SVCS Partnership

  • Emergency Medicine Physician
  • Port St Lucie, FL
  • NPI 1962451930
  NPD (past)

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

{
    "created_epoch": "1149465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1982643243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1898 NW AZALEA ST",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349949202",
            "telephone_number": "772-692-4577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 SE TIFFANY AVE",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349527521",
            "telephone_number": "772-398-3800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "GAVIN",
        "middle_name": "KEITH",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-05",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9102199",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alessandra Williamson, ARNP
• Masiai Willis-Jones, APRN FNP-C
• Charnelle Willis
• Wilnique Peaceful Adult Family Care Home
• Ann L Wilson, DDS
• Ishalon Shanquell Siedah Wilson, LMHC, LPC
• James E Wilson, PA-C
• Jerisha Wilson, RCSWI, LMSW
• Jessica Wilson
• Kaley Noelle Wimmer

• Physician Assistant in Port St Lucie, FL
• Providers in Port St Lucie, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 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.