JEROME LAURENCE WILSON (NPI# 1588765010) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588765010 |
| Entity Type | Individual |
| Full Name | JEROME LAURENCE WILSON |
| Credential | PA-C |
| Practice Address |
919 Main St Ste 101 Dyer IN 46311-3717 |
| Mailing Address |
Po Box 781076 Detroit MI 48278-1076 |
| Practice Telephone | 2198367531 |
| Practice Fax Number | 2198367593 |
| Mailing Telephone | 3175284800 |
| Mailing Fax Number | 3178651479 |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2019-12-16 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
10002805A | IN | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
085001943 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2605 Lincoln Hwy, Suite 121, Olympia Fields, IL 604611846 | 7733548990 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922648674 | Jerome Wilson | Counselor | 100 Diplomat Way, Thibodaux, LA 70301-4314 | 2020-01-10 |
| Street Address |
919 MAIN ST STE 101 |
| City | DYER |
| State | IN |
| Zip Code | 46311-3717 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386644268 | Jay S Hwang | Urology | 919 Main St Ste 101, Dyer, IN 46311 | 2005-07-21 |
| 1386601185 | Mark A Cabelin | Urology | 919 Main St Ste 101, Dyer, IN 46311-3717 | 2006-04-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407338858 | Leena Yousef-diaz | Nurse Practitioner | 1100 Joliet Street Suite #201, Dyer, IN 46311 | 2018-09-02 |
| 1518476639 | Kor Speech Therapy, LLC | Speech-Language Pathologist | 219 Primrose Dr., Dyer, IN 46311 | 2017-09-20 |
| 1861921207 | Derrick Durrah | Counselor | 2615 James Drive, Dyer, IN 46311 | 2017-06-08 |
| 1073962189 | Maria Lule | Pharmacist | 805 Joliet Road, Dyer, IN 46311 | 2016-06-09 |
| 1780072157 | Mario Munoz | Skilled Nursing Facility | 515 Audrey Ct, Dyer, IN 46311 | 2015-01-07 |
| 1457772451 | Lisa Jennifer Mickelson | Registered Nurse | 600 Joliet St., Kahler Middle School, Dyer, IN 46311 | 2013-12-18 |
| 1285055285 | Tanya D Burk-willson | Registered Nurse | 14600 W 81st St., Bibich Elementary, Dyer, IN 46311 | 2013-12-18 |
| 1013338011 | Mary Beth Rinaldi | Registered Nurse | 1121 Harrison Ave, Protsman Elementary, Dyer, IN 46311 | 2013-12-18 |
| 1023448057 | Franciscan Alliance | General Acute Care Hospital | 24 Joliet Street, 3da, Dyer, IN 46311 | 2013-11-12 |
| 1508078239 | Fatima Jaffer Md Sc PC | Internal Medicine | Physicians Pavilion Suite 101, 24 East Joliet Street, Dyer, IN 46311 | 2007-05-04 |
| Find all providers in zip 46311 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386289957 | Jordan Nickley Nemer | Physician Assistant | 270 E Day Rd Ste 200, Mishawaka, IN 46545-3444 | 2019-11-07 |
| 1760947329 | Ellen M Randall | Physician Assistant | 705 Riley Hospital Dr Ste 2514, Indianapolis, IN 46202-5109 | 2019-02-07 |
| 1710459839 | Alyssa Tripp | Physician Assistant | 1007 Lincolnway Rm 1107, La Porte, IN 46350-3201 | 2018-12-31 |
| 1992283899 | Kelsey Arnold | Physician Assistant | 275 W Bassett Rd Ste 2, Shelbyville, IN 46176-8575 | 2018-08-02 |
| 1396249926 | Deaconess Specialty Physicians, Inc | Physician Assistant | 1813 Willow St Ste 5a, Vincennes, IN 47591-4279 | 2018-03-20 |
| 1477924892 | Kristen Marie Ness | Physician Assistant | 13100 E 136th St Ste 2000, Fishers, IN 46037-9440 | 2015-10-12 |
| 1982945960 | Heather Bunnell | Physician Assistant | 3943 Hay Market Dr, Jeffersonville, IN 47130-8260 | 2013-03-15 |
| 1255685772 | Jarron J Lincoln | Physician Assistant | 5230 E Stop 11 Rd Ste 250, Indianapolis, IN 46237 | 2012-11-06 |
| 1427364926 | Rebecca Lou Autry | Physician Assistant | 10081 Fredericksburg Rd Nw, Depauw, IN 47115-8629 | 2010-08-23 |
| 1558685495 | Douglas D Kesler | Physician Assistant | 1411 S Creasy Lane, Suite 120, Lafayette, IN 47905-7433 | 2010-03-22 |
| 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.