EBONY STAR WILSON (NPI# 1063628667) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063628667 |
| Entity Type | Individual |
| Full Name | EBONY STAR WILSON |
| Credential | MHPP |
| Practice Address |
1704 Hwy 69 Truman AR 72472 |
| Mailing Address |
1815 Pleasant Grove Road Jonesboro AR 72404 |
| Practice Telephone | 8704834003 |
| Practice Fax Number | 8704834009 |
| Mailing Telephone | 8709336886 |
| Mailing Fax Number | 8709339395 |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2015-12-28 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 171M00000X | Case Manager/Care Coordinator | Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073156063 | Ebony N Wilson | Social Worker | 183 Iredell Ave, Troutman, NC 28166 | 2019-10-22 |
| 1023536463 | Ebony N Wilson | Counselor | 185 E. Elm St, #2057, Torrington, CT 06790-3726 | 2017-09-06 |
| 1013334622 | Ebony Wilson | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3514 Blair Ave, Saint Louis, MO 63107-3717 | 2014-03-20 |
| 1346744877 | Ebony Wilson | Behavior Technician | 1133 13th St, Columbus, GA 31901-2248 | 2018-03-20 |
| 1023475548 | Ebony Wilson | Social Worker | 622 Riverside Dr, Monroe, LA 71201-6211 | 2016-01-28 |
| Street Address |
1704 HWY 69 |
| City | TRUMAN |
| State | AR |
| Zip Code | 72472 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992114292 | Christopher Leroy Nance | Case Manager/Care Coordinator | 1704 Hwy 69, Truman, AR 72472 | 2014-08-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063039980 | First Step Arkansas, LLC | Occupational Therapist | 528 Industrial Park Access Rd, Trumann, AR 72472 | 2020-06-26 |
| 1982254710 | Brent A Davis | Physical Therapist | 516 Industrial Park Access Rd, Trumann, AR 72472 | 2019-09-13 |
| 1760992911 | Lorraine Irene Devries | Technician | 1316 Industrial Acess Drive, Trumann, AR 72472 | 2017-10-02 |
| 1902326226 | Logan Michael Schmidt | Dentist | 1711 Hwy 69 Blvd, Trumann, AR 72472 | 2017-06-27 |
| 1619228830 | Daniel Edward Ward | Case Manager/Care Coordinator | 1704 Hwy, 69, Trumann, AR 72472 | 2012-09-27 |
| 1003197542 | Mashae D. Rolland | Nurse Practitioner | 808 Highway 463 N, Trumann, AR 72472 | 2011-08-29 |
| 1982984118 | Denise Jackson | Case Manager/Care Coordinator | 1704 Highway 69, Trumann, AR 72472 | 2011-08-19 |
| 1134410467 | Dalisha Lareece Smith | Clinical Ethicist | 1704 Hwy. 69, Trumann, AR 72472 | 2011-04-20 |
| 1164727202 | Margaret Ann Peters | Case Manager/Care Coordinator | 809 West Main Suite C, Trumann, AR 72472 | 2011-01-21 |
| 1134379357 | Jeremiah Daniel Dillehay | Counselor | 170 4 Hwy. 69, Trumann, AR 72472 | 2008-09-24 |
| Find all providers in zip 72472 | ||||
| Taxonomy Code | 171M00000X |
| Grouping | Other Service Providers |
| Classification | Case Manager/Care Coordinator |
| A person who provides case management services and assists an individual in gaining access to needed medical, social, educational, and/or other services. The person has the ability to provide an assessment and review of completed plan of care on a periodic basis. This person is also able to take collaborative action to coordinate the services with other providers and monitor the enrollee’s progress toward the cost-effective achievement of objectives specified in the plan of care. Credentials may vary from an experience in the fields of psychology, social work, rehabilitation, nursing or a closely related human service field, to a related Assoc of Arts Degree or to nursing credentials. Some states may require certification in case management. |
| Notes: Source: CMS State Medicaid Manual Section 4442.3 [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992114292 | Christopher Leroy Nance | Case Manager/Care Coordinator | 1704 Hwy 69, Truman, AR 72472 | 2014-08-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386256014 | Jessica Marie Hazelip | Case Manager/Care Coordinator | 2126 N 1st St, Jacksonville, AR 72076-2870 | 2020-08-24 |
| 1619587383 | First Choice Care Management Consulting LLC | Case Manager/Care Coordinator | 155 Leatherwood Loop, Hot Springs, AR 71901-9580 | 2020-08-06 |
| 1649889775 | Haley Kathryn Mehan | Case Manager/Care Coordinator | 109 2nd Ave Sw Apt A, Gravette, AR 72736-6009 | 2020-07-24 |
| 1114535838 | Amber Michelle Cansler | Case Manager/Care Coordinator | 637 Ar-8, Amity, AR 71921 | 2020-07-20 |
| 1649807595 | Vickie Carter | Case Manager/Care Coordinator | 1704 Highway 49 West, Trumann, AR 72472-2029 | 2020-03-23 |
| 1619501087 | 1 Source Senior Care | Case Manager/Care Coordinator | 1820 Shelby Ln, Fayetteville, AR 72704-5255 | 2020-02-25 |
| 1194356964 | Yanira Harper | Case Manager/Care Coordinator | 204 Martha Ln Apt B, Gurdon, AR 71743-2210 | 2020-01-30 |
| 1326679473 | Megan Thomas | Case Manager/Care Coordinator | 3715 N Business Dr Ste 201, Fayetteville, AR 72703-5288 | 2020-01-28 |
| 1891335519 | Mallori Miller | Case Manager/Care Coordinator | 837 Willett Rd, Jonesboro, AR 72401 | 2020-01-10 |
| 1619516051 | Kyjione King | Case Manager/Care Coordinator | 721 S Gee St Ste A, Jonesboro, AR 72401-3308 | 2020-01-02 |
| Find all providers with the same taxonomy | ||||
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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.