RYAN M WILSON (NPI# 1306811567) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306811567 |
| Entity Type | Individual |
| Full Name | RYAN M WILSON |
| Credential | PA |
| Practice Address |
1350 S Hickory St Suite Pso Melbourne FL 32901-3224 |
| Mailing Address |
3300 S Fiske Blvd Rockledge FL 32955-4306 |
| Practice Telephone | 3214341401 |
| Practice Fax Number | 3214341667 |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2020-03-16 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363A00000X | Physician Assistant | P9102044 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
PA9102044 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 291346100 | 05 | |
| FL | FL MEDICARE | E8442U | 01 |
| FL | RR MEDICARE | P00466915 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1350 Hickory St Ste 101, Melbourne, FL 329013224 | 3214341401 | 3214341667 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831796093 | Ryan Alan Wilson | Physical Therapist | 1020 Queensgate Dr Ste B, Richland, WA 99352-9123 | 2020-10-01 |
| 1346889359 | Ryan Wilson | Occupational Therapist | 8320 5th Ave Ne Ste A, Seattle, WA 98115-4174 | 2019-12-23 |
| 1326530007 | Ryan Wilson | Social Worker | 1900 E Northern Pkwy Ste 300, Baltimore, MD 21239-2113 | 2018-05-30 |
| 1679920482 | Ryan Scott Wilson | Dentist | 3706 Davis Stuart Rd, Lewisburg, WV 24901-9463 | 2016-05-22 |
| 1174908651 | Ryan Wilson | Social Worker | 1905 W 8th St, #209, Loveland, CO 80537-5224 | 2015-07-24 |
| 1780811984 | Ryan Hastiin Wilson | Dentist | 6810 Menaul Blvd Ne Ste B, Albuquerque, NM 87110 | 2009-06-15 |
| 1407832454 | Ryan J Wilson | Optometrist | 422 South State Street, Geneseo, IL 61254-1536 | 2005-12-21 |
| 1922094184 | Ryan D Wilson | Emergency Medicine | 800 24th Ave, Norman, OK 73069 | 2005-09-23 |
| 1679171342 | Ryan Zachary Wilson | Physical Therapist | 342 Fifth Ave, Pelham, NY 10803-1204 | 2020-10-14 |
| 1396343463 | Ryan Wilson | Case Manager/Care Coordinator | 1111 W Mockingbird Ln Ste 1030, Dallas, TX 75247-5028 | 2020-10-12 |
| Street Address |
1350 S HICKORY ST SUITE PSO |
| City | MELBOURNE |
| State | FL |
| Zip Code | 32901-3224 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174526958 | Mark Edmund Pessa | Surgery | 1350 S Hickory St, Suite Pso, Melbourne, FL 32901 | 2005-05-24 |
| 1780041483 | Jacqueline Jennings | Registered Nurse | 1350 S Hickory St, Melbourne, FL 32901 | 2016-01-26 |
| 1396026027 | Jessica Mortin Wicker | Occupational Therapist | 1350 S Hickory St, Melbourne, FL 32901-3224 | 2011-09-08 |
| 1518248251 | Mary Haddadin | Occupational Therapist | 1350 S Hickory St, Melbourne, FL 32901-3224 | 2011-09-08 |
| 1215235338 | Lee Ann Finizio | Registered Nurse | 1350 S Hickory St, Melbourne, FL 32901-3224 | 2011-03-14 |
| 1700183506 | Space Coast Pathologists Pa | Clinical Medical Laboratory | 1350 S Hickory St, Melbourne, FL 32901-3224 | 2011-02-15 |
| 1548562127 | Kimberly Lynn Hunger | Pharmacist | 1350 S Hickory St, Melbourne, FL 32901-3224 | 2010-12-02 |
| 1457661902 | Jason Michael Perry | Pharmacist | 1350 S Hickory St, Melbourne, FL 32901-3224 | 2010-10-18 |
| 1063722569 | Catherine Anne Barbour | Social Worker | 1350 S Hickory St, Case Management Department, Melbourne, FL 32901-3224 | 2010-10-18 |
| 1346571684 | Stephen Paul Gilbert | Pharmacist | 1350 S Hickory St, Melbourne, FL 32901-3224 | 2010-01-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467062943 | George Pappas | Anesthesiologist Assistant | 1775 W. Hibiscus Blvd., Ste 215, Melbourne, FL 32901 | 2020-08-09 |
| 1124676820 | Abbi Dell Lee | Behavioral Analyst | 3251 Engineering St, Melbourne, FL 32901 | 2019-08-27 |
| 1750856878 | Jeffrey Michael Cavanagh | Behavior Technician | 3251 Engineering Street, Melbourne, FL 32901 | 2018-10-04 |
| 1740766021 | Amanda Miller | Behavior Technician | 1885 W Hibiscus Blvd, Melbourne, FL 32901 | 2018-07-19 |
| 1396244406 | Dragen II LLC | Urology | 129 W Hibiscus Blvd Ste D, Melbourne, FL 32901 | 2018-02-03 |
| 1225550692 | Cabrit Psychotherapy Services LLC | Marriage & Family Therapist | 100 Rialto Place, Suite 700, Melbourne, FL 32901 | 2017-07-07 |
| 1487188058 | Project Response, Inc. | Clinic/Center | 747 S. Apollo Boulevard, Melbourne, FL 32901 | 2017-04-20 |
| 1184174575 | Paulette Swanson | Physical Therapist | 611 East Sheridan Rd, Melbourne, FL 32901 | 2016-10-10 |
| 1841747839 | Nicholas Wilson | Social Worker | 3661 S. Babcock St., Melbourne, FL 32901 | 2016-09-07 |
| 1467804278 | Nickolas Hetherington | Occupational Therapist | 1900 S Harbor City Blvd Ste 108, Melbourne, FL 32901 | 2016-07-05 |
| Find all providers in zip 32901 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760888283 | Michael Dancy | Physician Assistant | 749 Mcdermott Ave, Melbourne, FL 32935-3038 | 2014-11-11 |
| 1164833240 | Stephen Schmoll | Physician Assistant | 205 E Nasa Blvd Fl 1, Melbourne, FL 32901-1950 | 2014-05-12 |
| 1174945521 | Dale P Greyslak Pa Pllc | Physician Assistant | 700 Jordan Blass Dr, Melbourne, FL 32940-1817 | 2014-01-19 |
| 1114163144 | Melissa L Hoppe | Physician Assistant | 3021 W Eau Gallie Blvd Ste 103, Suite 440, Melbourne, FL 32934-7005 | 2008-12-22 |
| 1144376088 | Carrie M Chapman | Physician Assistant | 1223 Gateway Dr Ste 2a, Melbourne, FL 32901-2607 | 2007-01-25 |
| 1972673184 | Physician Assistant Services of Florida LLC | Physician Assistant | 301 E Hibiscus Blvd, Melbourne, FL 32901-3105 | 2006-11-08 |
| 1013097567 | Miami First Assist, LLC | Physician Assistant | 1600 Sarno Road, Suite 15, Melbourne, FL 32935 | 2006-10-17 |
| 1336151067 | Bradley A Kramer | Physician Assistant | 8725 N Wickham Rd Ste 301, Melbourne, FL 32940-2240 | 2006-08-12 |
| 1649206517 | Eduardo Batista | Physician Assistant | 1600 Sarno Rd Ste 15, Melbourne, FL 32935-4990 | 2006-06-23 |
| 1548745037 | Kristin M. Kampenga | Physician Assistant | 1251 Hickory St, Melbourne, FL 32901-3221 | 2018-10-01 |
| Find all providers in MELBOURNE | ||||
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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.