MR. JACK KENNEY WILSON JR. (NPI# 1356349559) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356349559 |
| Entity Type | Individual |
| Full Name | MR. JACK KENNEY WILSON JR. |
| Credential | MD |
| Practice Address |
637 S Kerr Ave Wilmington NC 28403-8423 |
| Practice Telephone | 9107991810 |
| Practice Fax Number | 9104522571 |
| Mailing Telephone | 9107991810 |
| Mailing Fax Number | 9104522571 |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2012-09-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | 16755 | NC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | BCBS NC | 02701 | 01 |
| NC | 8902701 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114241239 | Jack H Wilson | Counselor | 11730 Highway 9 West, Stigler, OK 74462 | 2010-03-18 |
| 1821122102 | Jack A. Wilson | Dentist | 2200 Interstate 20 W Ste 200, Arlington, TX 76017-1649 | 2007-03-16 |
| 1396806519 | Jack Wilson | Pharmacist | 8823 Avenue L, Brooklyn, NY 11236-4781 | 2006-12-12 |
| 1790756542 | Jack Edward Wilson | Surgery | 3 Walnut St Ste 100, Lemoyne, PA 17043 | 2006-01-30 |
| 1518941517 | Jack Cook Wilson | Family Medicine | 612 E 9th St, Mountain Home, AR 72653-4804 | 2005-12-02 |
| 1043216807 | Jack Anthony Wilson | Dental Hygienist | 2654 Stacey Way, National City, CA 91950-7760 | 2005-06-24 |
| 1497949929 | Jack L Wilson | Dentist | 1721 S Cleveland Ave, Suite 100, Sioux Falls, SD 57103-5501 | 2007-08-28 |
| 1316002314 | Jack Wilson | Dentist | 12320 N 32nd St, Suite 1, Phoenix, AZ 85032-7154 | 2006-12-27 |
| 1598774465 | Jack W. Wilson | Dentist | 534 Luzerne St, Mount Ida, AR 71957-9449 | 2006-08-07 |
| 1033125299 | Jack M Wilson | Emergency Medicine | 6655 Alvarado Rd, San Diego, CA 92120-5208 | 2006-07-31 |
| Street Address |
637 S KERR AVE |
| City | WILMINGTON |
| State | NC |
| Zip Code | 28403-8423 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194740647 | Robert J Kastner | Family Medicine | 637 S Kerr Ave, Wilmington, NC 28403-8423 | 2006-07-13 |
| 1265479091 | Southeastern Medical Group, P.a. | Internal Medicine | 637 S Kerr Ave, Wilmington, NC 28403-8423 | 2006-06-01 |
| 1437159530 | Alan Efird Thomas | Internal Medicine | 637 S Kerr Ave, Wilmington, NC 28403-8423 | 2005-07-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902413875 | Ymca of Southeastern Nc | Health Educator | 2710 Market Street, Wilmington, NC 28403 | 2020-09-25 |
| 1659917334 | Noa Alper | Occupational Therapist | 5412 Old Garden Road, Wilmington, NC 28403 | 2019-11-18 |
| 1992346340 | Nancy Rosita Carson | Technician | 5608 Locke Str. Apt 108, Wilmington, NC 28403 | 2019-10-07 |
| 1912484585 | Jennifer Nicole Perry | Behavior Technician | 349 Campus Cv, Wilmington, NC 28403 | 2018-07-25 |
| 1386159929 | Monumental Foundations LLC | Clinic/Center | Plum Tree Plaza 925 South Kerr Ave Suite F4, Wilmington, NC 28403 | 2017-12-05 |
| 1114445731 | Jacqulyn Craichy | Speech-Language Pathologist | 75 Cavalier Drive, Wilmington, NC 28403 | 2017-09-04 |
| 1730638545 | Ashley Mcneil | Durable Medical Equipment & Medical Supplies | 3435 Wilshire Blvd Apt 203, Wilmington, NC 28403 | 2016-09-22 |
| 1306204276 | Valerie Pringle Jones | Physical Therapist | 1717 Shipyard Blvd. Ste 350, Wilmington, NC 28403 | 2016-02-05 |
| 1689039992 | Lifeline Treatment Center | Clinic/Center | 5710 Oleander Dr Ste 100, Wilmington, NC 28403 | 2015-12-31 |
| 1750758264 | Melissa Beatson | Speech-Language Pathologist | 4014 Oleander Drive, Ste. 3b, Coastal Speech & Language Pllc, Wilmington, NC 28403 | 2015-09-01 |
| Find all providers in zip 28403 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891357760 | Essentials Medical Group De LLC | Internal Medicine | 3700 Lancaster Pike Ste 301, Wilmington, DE 19805-1511 | 2019-07-01 |
| 1467815191 | Jenna Leigh Laughlin | Internal Medicine | 501 W 14th St., Wilmington, DE 19801 | 2016-03-31 |
| 1578982666 | Shannon E. Pan | Internal Medicine | 3301 Lancaster Pike Ste 9, Wilmington, DE 19805-1436 | 2014-04-16 |
| 1922428044 | Katelyn Fritzges | Internal Medicine | 3506 Kennett Pike Ste 230, Wilmington, DE 19807-3019 | 2014-04-16 |
| 1902241441 | Brenden David Connor | Internal Medicine | 2006 Limestone Rd Ste 7, Wilmington, DE 19808 | 2013-05-09 |
| 1619221744 | Monika Partyka-zdunek | Internal Medicine | 625 Black Gates Rd, Wilmington, DE 19803-2239 | 2012-10-26 |
| 1982963443 | Kathryn Sweeney El-amraoui | Internal Medicine | 4512 Kirkwood Hwy Ste 300, Wilmington, DE 19808-5129 | 2012-05-03 |
| 1558635714 | Allison Bronwen Evans | Internal Medicine | 1203 Barley Mill Rd, Wilmington, DE 19807-2225 | 2012-03-05 |
| 1225301971 | Romil Rasik Patel | Internal Medicine | 2006 Limestone Road, Suite 7, Wilmington, DE 19808 | 2012-02-10 |
| 1982976692 | Joseph M Molina Md Professional Corporation-southern California | Internal Medicine | 445 E. Anaheim Street, #h, Wilmington, CA 90744-4600 | 2012-01-27 |
| Find all providers in WILMINGTON | ||||
| City | WILMINGTON |
| Zip Code | 28403 |
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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.