DESTONEE WILSON (NPI# 1174041578) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174041578 |
| Entity Type | Individual |
| Full Name | DESTONEE WILSON |
| Credential | PA-C |
| Practice Address |
1650 S Beach St Fort Worth TX 76105 |
| Mailing Address |
Po Box 732973 Dallas TX 75373-2973 |
| Practice Telephone | 8177021100 |
| Practice Fax Number | 8177026124 |
| Mailing Telephone | 8177028450 |
| Enumeration Date | 2017-09-06 |
| Last Update Date | 2018-11-07 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA12177 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363A00000X | Physician Assistant | 279726-1206 | UT | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2295 S Foothill Dr, Salt Lake City, UT 841094000 | 8014863021 | |
| 6360 S 3000 E Ste 100, Salt Lake City, UT 841216924 | 8013651032 | 8013651036 |
| 13953 S Bangerter Pkwy, Draper, UT 840205429 | 3859004090 | 8013651033 |
| Street Address |
1650 S BEACH ST |
| City | FORT WORTH |
| State | TX |
| Zip Code | 76105 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700811163 | Dara Grieger | Preventive Medicine | 1650 S Beach St, Fort Worth, TX 76105-2209 | 2006-07-12 |
| 1154960680 | Issis S Aleman | Nurse Practitioner | 1650 S Beach St, Fort Worth, TX 76105-2209 | 2020-01-01 |
| 1306387592 | Felicia Denette Williams | Nurse Practitioner | 1650 S Beach St, Fort Worth, TX 76105-2209 | 2017-03-20 |
| 1184019929 | Sheelarani Joseph | Nurse Practitioner | 1650 S Beach St, Fort Worth, TX 76105 | 2015-03-30 |
| 1174915805 | Sun A Chung | Nurse Practitioner | 1650 S Beach St, Fort Worth, TX 76105 | 2015-03-04 |
| 1942690284 | Josephine N Ndungu | Nurse Practitioner | 1650 S Beach St, Fort Worth, TX 76105-2209 | 2015-01-26 |
| 1518370451 | Dolly Kay Barter | Nurse Practitioner | 1650 S Beach St, Fort Worth, TX 76105-2209 | 2014-06-09 |
| 1235364530 | Rose M Julian | Nurse Practitioner | 1650 S Beach St, Fort Worth, TX 76105-2209 | 2009-05-16 |
| 1902090525 | Ashley Lynne Schwartz | Physician Assistant | 1650 S Beach St, Fort Worth, TX 76105-2209 | 2007-08-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477030567 | Brandon Ronald Lee | Optometrist | 2644 E Berry St., Fort Worth, TX 76105 | 2018-07-23 |
| 1366935165 | National Vision, Inc. | Technician/Technologist | 2644 East Berry Street, Fort Worth, TX 76105 | 2018-06-07 |
| 1609363100 | Courtney Mae Gramley | Specialist/Technologist | 1201 Wesleyan St., Fort Worth, TX 76105 | 2018-04-19 |
| 1992213078 | Fresenius Medical Care Se Fort Worth, LLC | Clinic/Center | 3708 E Rosedale St, Fort Worth, TX 76105 | 2018-01-11 |
| 1285978692 | Wal-mart Stores Texas LLC | Technician/Technologist | 2900 Renaissance Square, Fort Worth, TX 76105 | 2012-11-26 |
| 1548584998 | Access Dental of Berry, P.a. | Dentist | 4201 E. Berry Street, Suite #15, Fort Worth, TX 76105 | 2010-03-15 |
| 1811211261 | Access Dental of Rosedale P.a. | Dentist | 3620 E. Rosedale Street, Fort Worth, TX 76105 | 2010-03-15 |
| 1396345799 | Danielle Hampton | Pharmacist | Walmart Pharmacy, 2900 Renaissance Square, Fort Worth, TX 76105 | 2020-10-27 |
| 1053661207 | Ji Yoon Kim | Dentist | 3620 E. Rosedale Street, Fort Worth, TX 76105 | 2012-09-14 |
| 1619297736 | Access Orthodontics of Rosedale, P.a. | Dentist | 3620 E. Rosedale Street, Fort Worth, TX 76105 | 2010-06-11 |
| Find all providers in zip 76105 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811596927 | Emily Lau | Physician Assistant | 3848 N Tarrant Pkwy Ste 120, Fort Worth, TX 76244-5422 | 2020-10-20 |
| 1629681952 | Anum Bashwani | Physician Assistant | 5601 Bridge St Ste 450, Fort Worth, TX 76112-2305 | 2020-08-26 |
| 1780200881 | Emily Brown Holloway | Physician Assistant | 1904 Turner Ridge Dr Apt 5202, Fort Worth, TX 76110-2499 | 2020-06-24 |
| 1679196570 | Maria Cristela Mosso | Physician Assistant | 4521 S Hulen St Ste 118, Fort Worth, TX 76109-4954 | 2020-05-26 |
| 1679195978 | Jacob Torre | Physician Assistant | 1701 River Run Ste 1118, Fort Worth, TX 76107-6557 | 2020-05-11 |
| 1871122382 | Kenaud Jeune | Physician Assistant | 5817 Fairglen Ave Apt 312, Fort Worth, TX 76137-6810 | 2020-04-06 |
| 1922635648 | Lauren Elizabeth Studey | Physician Assistant | 3470 Sagecrest Ter, Fort Worth, TX 76109-2555 | 2020-03-24 |
| 1033743612 | James Bregg Reedy | Physician Assistant | 200 W Magnolia Ave Ste 201, Fort Worth, TX 76104-7657 | 2020-02-24 |
| 1992335194 | Alexandria Christine Rios | Physician Assistant | 5904 Rockhill Rd, Fort Worth, TX 76112-3047 | 2020-01-16 |
| 1982253605 | Kelly Ann Klein | Physician Assistant | 6708 River Bend Rd, Fort Worth, TX 76132-1108 | 2019-09-05 |
| Find all providers in FORT WORTH | ||||
| City | FORT WORTH |
| Zip Code | 76105 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.