MS. BRANDY CRUSE WILSON (NPI# 1770547580) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770547580 |
| Entity Type | Individual |
| Full Name | MS. BRANDY CRUSE WILSON |
| Other Name | BRANDY CRUSE |
| Credential | PA-C |
| Practice Address |
4414 Lake Boone Trl Ste 108 Raleigh NC 27607-7522 |
| Practice Telephone | 9197842300 |
| Mailing Telephone | 9197842300 |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2020-03-31 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 000104058 | NC | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 1770547580 | 05 | |
| NC | BCBSNC | 189Q6 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 115 Heart Dr, Greenville, NC 278348982 | 2527444400 | 2527443987 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275145344 | Brandy Wilson | Day Training/Habilitation Specialist | 37301 Radde St, Clinton Township, MI 48036-2932 | 2020-08-20 |
| 1255801791 | Brandy M Wilson | Nurse Practitioner | 11670 Highway 21 S, Union, MS 39365-9198 | 2018-11-27 |
| 1588186969 | Brandy Wilson | Social Worker | 153 Cameron Way Circle, Winston Salem, NC 27103 | 2017-07-07 |
| 1972973261 | Brandy Wilson | Case Manager/Care Coordinator | 5761 Louis Prima Dr E, New Orleans, LA 70128 | 2015-09-30 |
| 1215245048 | Brandy Wilson | Rehabilitation Practitioner | 336 Lance Ave, North Las Vegas, NV 89030-3869 | 2010-09-14 |
| 1174846455 | Brandy L Wilson | Speech-Language Pathologist | 836 S Bishop St, Garden Apt, Chicago, IL 60607-4022 | 2010-03-01 |
| 1952949182 | Brandy Wilson | Nurse Practitioner | 314 Main St Ste B, Monticello, MS 39654-3702 | 2019-12-18 |
| 1992368658 | Brandy L Wilson | Behavioral Analyst | 1460 Nw Vivion Rd Ste B, Kansas City, MO 64118-4555 | 2019-04-18 |
| 1881164002 | Brandy Denise Wilson | Nurse's Aide | 140 Dameron Ave, Knoxville, TN 37917-6413 | 2018-11-30 |
| 1689923567 | Brandy Nicole Wilson | Counselor | 112 N Mckinley, Chandler, OK 74834 | 2012-09-06 |
| Street Address |
4414 LAKE BOONE TRL STE 108 |
| City | RALEIGH |
| State | NC |
| Zip Code | 27607-7522 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811960412 | Stephen Wayne Smith | Internal Medicine | 4414 Lake Boone Trl Ste 108, Raleigh, NC 27607-7522 | 2006-02-13 |
| 1013473180 | Sara Beth Liles | Nurse Practitioner | 4414 Lake Boone Trl Ste 108, Raleigh, NC 27607-7522 | 2019-02-14 |
| 1871065656 | Morgan Elaine Schultingkemper | Physician Assistant | 4414 Lake Boone Trl Ste 108, Raleigh, NC 27607-7522 | 2018-12-18 |
| 1376058024 | Kerri Michele Jones | Physician Assistant | 4414 Lake Boone Trl Ste 108, Raleigh, NC 27607-7522 | 2017-12-04 |
| 1871988097 | Kimberly A Trinh | Physician Assistant | 4414 Lake Boone Trl Ste 108, Raleigh, NC 27607-7522 | 2015-04-03 |
| 1316386303 | Matthew Edward Gibson | Surgery | 4414 Lake Boone Trl Ste 108, Raleigh, NC 27607 | 2013-06-23 |
| 1952745242 | Ryan Joseph Meehan | Surgery | 4414 Lake Boone Trl Ste 108, Raleigh, NC 27607-7522 | 2013-04-17 |
| 1427027242 | Suman M Wasan | Internal Medicine | 4414 Lake Boone Trl Ste 108, Raleigh, NC 27607 | 2006-03-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972093144 | Kyndra Lawson | Behavior Technician | 5121 Kingdom Way, Suite 100, Raleigh, NC 27607 | 2018-05-14 |
| 1578082905 | Margaret Roberts Bova | Dietitian, Registered | 4207 Lake Boone Trail, Suite 210, Raleigh, NC 27607 | 2017-09-18 |
| 1184141897 | Chricat Garrard | Nurse Practitioner | 4207 Lake Boone Trl Ste 200, Raleigh, NC 27607 | 2017-08-23 |
| 1487178620 | John Patrick Morton | Pharmacist | 2411 Landmark Dr, Raleigh, NC 27607 | 2017-07-31 |
| 1023538857 | Heather Margaret Mazzola | Audiologist | 7800 Lake Boone Trail, 100, Raleigh, NC 27607 | 2017-06-22 |
| 1790216984 | North Carolina Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 2411 Landmark Drive, Raleigh, NC 27607 | 2017-03-21 |
| 1558819516 | Corilin Nocito Meggitt | Nurse Practitioner | 4505 Fair Meadows Ln Ste 102, Raleigh, NC 27607 | 2016-09-19 |
| 1942757034 | Stacie Walker | Obstetrics & Gynecology | 4414 Lake Boone Trl Ste 311, Raleigh, NC 27607 | 2016-09-06 |
| 1831644533 | Alisa Smajlagic Howe | Nurse Practitioner | 4210 Lake Boone Trail, Rex Rehab & Nursing Center, Raleigh, NC 27607 | 2016-08-23 |
| 1235598632 | Yoseph Saleh | Dentist | 107 Minden Ln, Raleigh, NC 27607 | 2016-02-15 |
| Find all providers in zip 27607 | ||||
| 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 |
|---|---|---|---|---|
| 1457961682 | Megan Kathleen Brown | Physician Assistant | 3024 New Bern Ave Ste 102, Raleigh, NC 27610-1247 | 2020-08-03 |
| 1124640651 | Kayla Marie Sincock | Physician Assistant | 12205 Harcourt Dr, Raleigh, NC 27613-5603 | 2020-05-06 |
| 1093340531 | Hannah Stanifer | Physician Assistant | 510 N Wilmington St Apt 227, Raleigh, NC 27604-8021 | 2020-03-05 |
| 1962035642 | Brianna Stolz | Physician Assistant | 3811 Ed Dr Ste 110, Raleigh, NC 27612-2393 | 2020-02-20 |
| 1316577737 | Jacey Elizabeth Byers | Physician Assistant | 700 Hawes Ct Apt C, Raleigh, NC 27608-1745 | 2020-01-24 |
| 1033756598 | Julie A Romeis | Physician Assistant | 1929 N Hills Dr Unit G, Raleigh, NC 27612-4022 | 2019-12-04 |
| 1346886769 | Pooja Parmar | Physician Assistant | 8804 Bluff Pointe Ct, Raleigh, NC 27615-4172 | 2019-11-20 |
| 1649829557 | Bryan Edwards | Physician Assistant | 4551 New Bern Ave Ste A100, Raleigh, NC 27610-1551 | 2019-09-04 |
| 1790343192 | Savanah Palen Mullen | Physician Assistant | 10208 Cerny St Ste 204, Raleigh, NC 27617-7885 | 2019-05-31 |
| 1356906184 | Andrew Paul Apicella | Physician Assistant | 3024 New Bern Ave Ste 302, Raleigh, NC 27610-1247 | 2019-05-07 |
| Find all providers in RALEIGH | ||||
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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.