SHANE DAVID WILSON (NPI# 1437624236) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1437624236 |
| Entity Type | Individual |
| Full Name | SHANE DAVID WILSON |
| Credential | AGACNP-BC |
| Practice Address |
1249 15th St Ste 4000 Huntington WV 25701-3663 |
| Mailing Address |
201 Parkstone Dr Fraziers Bottom WV 25082-6977 |
| Practice Telephone | 3047663600 |
| Mailing Telephone | 3043821090 |
| Enumeration Date | 2018-10-08 |
| Last Update Date | 2020-10-30 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LA2100X |
Nurse Practitioner Specialization: Acute Care |
63040 | WV | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LG0600X |
Nurse Practitioner Specialization: Gerontology |
63040 | WV | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1200 J D Anderson Dr, Morgantown, WV 265053494 | 3045981330 | 3045981609 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669952966 | Shane Wilson | Non-emergency Medical Transport (VAN) | 1522 S Tyler St, Little Rock, AR 72204 | 2018-08-16 |
| 1982009569 | Shane Michael Wilson | Chiropractor | 938 Wrens Roost Cir, 2, Memphis, TN 38119-0510 | 2014-10-25 |
| 1063742138 | Shane Ray Wilson | Counselor | 2820 Weymouth Way, Norman, OK 73071-7269 | 2010-01-12 |
| 1902440035 | Shane Marcus Wilson | Physical Therapy Assistant | 10600 Mastin St, Overland Park, KS 66212-5723 | 2019-11-01 |
| 1477808467 | Shane Charles Wilson | Internal Medicine | 450 E Sigler Ave, Ste A, Memphis, MO 63555-1726 | 2012-07-17 |
| 1245548239 | Shane Wilson | Rehabilitation Practitioner | 741 Rancho Via Dr, Sparks, NV 89434-4051 | 2010-09-23 |
| 1336314392 | Shane Wilson | Counselor | 1470 W Herndon Ave, Suite 300, Fresno, CA 93711-0552 | 2008-04-29 |
| Street Address |
1249 15TH ST STE 4000 |
| City | HUNTINGTON |
| State | WV |
| Zip Code | 25701-3663 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154617678 | Carlos Alberto Rueda Rios | Internal Medicine | 1249 15th St Ste 4000, Huntington, WV 25701-3663 | 2011-06-23 |
| 1588055362 | Kadara Wade | Nurse Practitioner | 1249 15th St Ste 4000, Huntington, WV 25701-3663 | 2015-02-14 |
| 1508132960 | Jason Palmer Mader | Internal Medicine | 1249 15th St Ste 4000, Huntington, WV 25701-3663 | 2012-03-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922607803 | Sara Tonya Hicks | Technician | 742 4th Avenue, Huntington, WV 25701 | 2020-10-21 |
| 1316550791 | Ethan Scott Miller | Counselor | 1538 Charleston Ave., Huntington, WV 25701 | 2020-08-26 |
| 1336752674 | Brock Riley Hapney | Student in an Organized Health Care Education/Training Program | 1538 Charelston Avenue, Huntington, WV 25701 | 2020-08-26 |
| 1558972224 | Ardith Ruth Bartram | Technician | 4045 C 8th Street Road, Huntington, WV 25701 | 2020-08-14 |
| 1144839614 | Randall Edward Short | Behavior Technician | 10th Sixth Avenue West, Huntington, WV 25701 | 2020-07-30 |
| 1609495191 | Melanie Jean Howard | Pharmacist | 1538 Charleston Avenue, Huntington, WV 25701 | 2020-04-14 |
| 1205472016 | Kelly Kauffer | Technician | 1012 Johns Court, Huntington, WV 25701 | 2019-11-27 |
| 1265082648 | Matt France | Technician | 3650 Taymor Rd, Huntington, WV 25701 | 2019-09-17 |
| 1538649348 | Kathryn Markus | Pharmacist | 1500 Medical Center Drive, Huntington, WV 25701 | 2018-08-21 |
| 1487155636 | Heather Marie Rogers | Nurse Practitioner | 940 4th Ave, Huntington, WV 25701 | 2018-02-23 |
| Find all providers in zip 25701 | ||||
| Taxonomy Code | 363LA2100X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Acute Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245488410 | Paul Edmond Cowsar | Nurse Practitioner | 300 8th St Ste 201b, Huntington, WV 25701-1413 | 2008-08-29 |
| 1073162772 | Kali Crawford | Nurse Practitioner | 1340 Hal Greer Blvd, Huntington, WV 25701-3800 | 2019-09-05 |
| 1386296192 | Christine Rose Campanello | Nurse Practitioner | 270 Park Avenue, Huntington, NY 11743 | 2019-07-11 |
| 1063076388 | Heather Jasmine Holton | Nurse Practitioner | 2828 1st Ave Ste 200, Huntington, WV 25702-1236 | 2019-04-23 |
| 1306302468 | Jessica Paige Sparks | Nurse Practitioner | 2828 1st Ave Ste 510, Huntington, WV 25702-1236 | 2019-02-13 |
| 1548739899 | Lisa Dee Reilly | Nurse Practitioner | 270 Park Ave, Huntington, NY 11743-2787 | 2018-11-15 |
| 1366896649 | Ashley Sue Denning | Nurse Practitioner | 10 Adams Ave, Huntington, WV 25701-1131 | 2016-04-22 |
| 1861731648 | Jovy Young | Nurse Practitioner | 270 Park Ave, Huntington, NY 11743-2787 | 2013-02-13 |
| 1922397074 | Stephen Scott Metheny | Nurse Practitioner | 5221 Us Route 60 E, Huntington, WV 25705-2022 | 2011-03-29 |
| 1568688299 | Suzanne M Spooner | Nurse Practitioner | 1600 Medical Center Dr, Suite B500, Huntington, WV 25701-3656 | 2007-04-18 |
| Find all providers in HUNTINGTON | ||||
| City | HUNTINGTON |
| Zip Code | 25701 |
Please comment or provide details below to improve the information on SHANE DAVID WILSON.
| 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.