JACKILYN WILSON (NPI# 1811440092) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811440092 |
| Entity Type | Individual |
| Full Name | JACKILYN WILSON |
| Credential | NP |
| Practice Address |
3120 Governors Place Blvd Dayton OH 45409-1328 |
| Mailing Address |
6680 Poe Ave Suite 200 Dayton OH 45414-2854 |
| Practice Telephone | 9372931622 |
| Practice Fax Number | 9372456308 |
| Mailing Telephone | 9372808400 |
| Mailing Fax Number | 9372808373 |
| Enumeration Date | 2016-07-25 |
| Last Update Date | 2019-01-30 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LA2100X |
Nurse Practitioner Specialization: Acute Care |
019508 | OH | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LA2100X |
Nurse Practitioner Specialization: Acute Care |
RN328660 | OH | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3120 Governors Place Blvd, Dayton, OH 454091328 | 9372931622 | 9372456308 |
| Street Address |
3120 GOVERNORS PLACE BLVD |
| City | DAYTON |
| State | OH |
| Zip Code | 45409-1328 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508471376 | Oncology Hematology Care, Inc | Internal Medicine | 3120 Governors Place Blvd, Dayton, OH 45409-1328 | 2020-09-09 |
| 1972953032 | Kristina Marie Stallard | Registered Nurse | 3120 Governors Place Blvd, Dayton, OH 45409-1328 | 2016-06-20 |
| 1407236680 | Johnna Beth Stamper | Nurse Practitioner | 3120 Governors Place Blvd, Dayton, OH 45409-1328 | 2015-06-03 |
| 1437422243 | Kara Elizabeth Warren | Nurse Practitioner | 3120 Governors Place Blvd, Dayton, OH 45409-1328 | 2012-02-10 |
| 1649598467 | Tracey Senften Hardin | Nurse Practitioner | 3120 Governors Place Blvd, Dayton, OH 45409-1328 | 2010-05-05 |
| 1568694800 | Carol M Nikolai | Nurse Practitioner | 3120 Governors Place Blvd, Dayton, OH 45409-1328 | 2009-08-20 |
| 1700015989 | Jennifer R Curtis | Nurse Practitioner | 3120 Governors Place Blvd, Dayton, OH 45409 | 2009-07-08 |
| 1023058427 | Mark D Romer | Internal Medicine | 3120 Governors Place Blvd, Dayton, OH 45409-1328 | 2006-06-07 |
| 1083664023 | Ketan S. Shah | Internal Medicine | 3120 Governors Place Blvd, Dayton, OH 45409-1328 | 2006-05-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487276457 | Matthew R Schaeffer | Surgery | 128 E Apple St., Wche 7th Floor, Dayton, OH 45409 | 2020-05-13 |
| 1699237545 | Elizabeth Joan Hudson | Student in an Organized Health Care Education/Training Program | 1 Wyoming Street Miami Valley Hospital Medical Educatio, Dayton, OH 45409 | 2019-04-01 |
| 1760941066 | Courtney Lyn Johnson | Surgery | 128 East Apple Street, Wche 7th Floor, Dayton, OH 45409 | 2019-03-16 |
| 1477057529 | Adam Joseph Langer | Student in an Organized Health Care Education/Training Program | 128 E. Apple St Suite 3800, Wright State University Dept of Ob/gyn, Dayton, OH 45409 | 2018-03-22 |
| 1659870939 | Timothy Wall | Student in an Organized Health Care Education/Training Program | 128 East Apple St., 2nd Floor, Dayton, OH 45409 | 2018-02-01 |
| 1124551411 | Adam Schmerge Deardorff | Student in an Organized Health Care Education/Training Program | 30 E Apple St Ste 6257, Dayton, OH 45409 | 2017-04-04 |
| 1205205358 | Kelby Snorf | Physician Assistant | 30 E Apple Street, Suite 3300, Dayton, OH 45409 | 2015-09-18 |
| 1689054223 | Jessica Ezinne Ugwu | Family Medicine | 30 E Apple St., Suite Nw 3300, Dayton, OH 45409 | 2015-06-08 |
| 1679983084 | Jude Anneryan Cohen | Registered Nurse | 1200 W. Dorothy Lane, Southdale Elementary School, Kettering, OH 45409 | 2014-05-07 |
| 1730517087 | Jesse Wayne Clark | Counselor | 65 Grady Ct, Dayton, OH 45409 | 2013-10-24 |
| Find all providers in zip 45409 | ||||
| Taxonomy Code | 363LA2100X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Acute Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982202768 | Stephanie Yvonne Alexander | Nurse Practitioner | 2936 S Patterson Blvd, Dayton, OH 45419-1311 | 2020-10-13 |
| 1326659467 | Crystal N Weaver | Nurse Practitioner | 859 E Social Row Rd, Dayton, OH 45458-4709 | 2020-08-12 |
| 1720501521 | Patricia Ann Potts | Nurse Practitioner | 5338 Philadelphia Dr, Suite B, Dayton, OH 45415-3061 | 2017-07-24 |
| 1891153276 | Rebecca Erin Donahue | Nurse Practitioner | 8069 Washington Village Dr, Dayton, OH 45458-1847 | 2016-02-01 |
| 1487023370 | Amy Michelle Wiley | Nurse Practitioner | 128 E. Apple St., Dayton, OH 45409-2793 | 2015-09-21 |
| 1851477855 | Shiron Devere Jones | Nurse Practitioner | 1222 S Patterson Blvd Ste 230, Dayton, OH 45402-2643 | 2006-10-31 |
| 1609489152 | Kristen Leigh Hayhow | Nurse Practitioner | 30 E Apple St Ste 1480, Dayton, OH 45409-2932 | 2020-08-25 |
| 1235763855 | Melissa Sue Einink | Nurse Practitioner | 1 Wyoming St, Dayton, OH 45409-2722 | 2020-02-24 |
| 1518506377 | Syed Taqi Hussain | Nurse Practitioner | 8881 N Main St, Dayton, OH 45415-1333 | 2019-12-26 |
| 1144874314 | Priscilla Ann Blevins | Nurse Practitioner | 30 E Apple St, Dayton, OH 45409-2939 | 2019-07-26 |
| Find all providers in DAYTON | ||||
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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.