JAELA MARIE WILSON (NPI# 1881174878) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881174878 |
| Entity Type | Individual |
| Full Name | JAELA MARIE WILSON |
| Credential | ATC |
| Practice Address |
1801 Fayetteville St Durham NC 27707-3129 |
| Mailing Address |
10311 Crestgate Ter Apt 104 Raleigh NC 27617-1803 |
| Practice Telephone | 9195305559 |
| Mailing Telephone | 7577194436 |
| Enumeration Date | 2018-08-19 |
| Last Update Date | 2018-08-19 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2081S0010X |
Physical Medicine & Rehabilitation Specialization: Sports Medicine |
LAT-4017 | NC | Allopathic & Osteopathic Physicians |
| Street Address |
1801 FAYETTEVILLE ST |
| City | DURHAM |
| State | NC |
| Zip Code | 27707-3129 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487645321 | Jason L. Swartz | Pharmacist | 1801 Fayetteville St, Durham, NC 27707-3129 | 2005-10-31 |
| 1316589203 | Reginald Fennell | Nurse Practitioner | 1801 Fayetteville St, Durham, NC 27707-3129 | 2019-10-11 |
| 1306333943 | Emily K Kahn | Nurse Practitioner | 1801 Fayetteville St, Durham, NC 27707-3129 | 2018-04-19 |
| 1639605769 | Colin Gregory Biegas | Specialist/Technologist | 1801 Fayetteville St, Durham, NC 27707-3129 | 2017-05-10 |
| 1194251223 | Lorianne Tant | Specialist/Technologist | 1801 Fayetteville St, B103 Walker Complex, Durham, NC 27707-3129 | 2017-05-10 |
| 1083140198 | Adrian Gaddis | Specialist/Technologist | 1801 Fayetteville St, B103 Walker Complex, Durham, NC 27707-3129 | 2017-05-10 |
| 1235665779 | Sean Thomas | Specialist/Technologist | 1801 Fayetteville St, Box 19705, Durham, NC 27707-3129 | 2017-05-03 |
| 1669918942 | Danielle Lungelow | Registered Nurse | 1801 Fayetteville St, Durham, NC 27707-3129 | 2017-01-11 |
| 1265898274 | Carolyn Moore | Psychologist | 1801 Fayetteville St, Durham, NC 27707-3129 | 2016-01-06 |
| 1952774309 | Jerrod Maxwell Sadler | Specialist/Technologist | 1801 Fayetteville St, Durham, NC 27707-3129 | 2015-11-06 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538785928 | Ceara Smith | Social Worker | 1415 W Nc 54 Buidling 200, Suite 111, Durham, NC 27707 | 2020-06-22 |
| 1114554094 | Lauren Michelle Grosse | Physician Assistant | Fastmed Urgent Care 7010 Nc-751, Durham, NC 27707 | 2020-03-23 |
| 1386289635 | Ashley Bailey | Counselor | 1801 Fayetteville Street, Durham, NC 27707 | 2019-11-11 |
| 1881249886 | Erin Ramona Leger | Physical Therapist | 3706 Mayfair St, Ste 120, Durham, NC 27707 | 2019-08-06 |
| 1417417262 | Carmen Elisabeth Sanchez | Psychologist | 3326 Durham Chapel Hill Blvd Bldg D, Durham, NC 27707 | 2019-03-20 |
| 1477026144 | Pope Behavioral Health and Wellness | Counselor | 5102 Chapel Hill Durham Blvd., Suite 101, Durham, NC 27707 | 2019-01-06 |
| 1043780778 | Jessica Ann Revels | Counselor | 1415 West North Carolina 54, Building 100 Suite # 204, Durham, NC 27707 | 2018-11-26 |
| 1558830125 | Michael Brown | Counselor | 1502 W Nc-54, Suite 505, Durham, NC 27707 | 2018-11-13 |
| 1780152827 | Cassandra Gerwig Shaw | Registered Nurse | 5324 Mcfarland Dr Ste 310, Durham, NC 27707 | 2018-11-07 |
| 1942776232 | Lisa J Keskitalo | Physical Therapist | 3708 Mayfair St Ste 120, Durham, NC 27707 | 2018-10-15 |
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| Taxonomy Code | 2081S0010X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Physical Medicine & Rehabilitation |
| Specialization | Sports Medicine |
| A physician who specializes in Sports Medicine is responsible for continuous care related to the enhancement of health and fitness as well as the prevention of injury and illness. The specialist possesses knowledge and experience in the promotion of wellness and the prevention of injury from many areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation and injuries. It is the goal of a Sports Medicine specialist to improve the healthcare of the individual engaged in physical exercise. |
| Notes: Source: American Board of Medical Specialties, 2009. www.abms.org [7/1/2009: definition added] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972153419 | Meredith Elise Bland | Physical Medicine & Rehabilitation | 3475 Erwin Rd, Durham, NC 27705-0005 | 2019-09-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679130744 | Mojo Sportclinic, LLC | Physical Medicine & Rehabilitation | 6859 Monument Dr, Wilmington, NC 28405-4178 | 2019-05-23 |
| 1679138176 | Jeneva Gatses | Physical Medicine & Rehabilitation | 13759 Cinnabar Pl, Huntersville, NC 28078-5342 | 2019-05-09 |
| 1285159905 | Austin John Hille | Physical Medicine & Rehabilitation | 400 Landis Ct. #203, Asheville, NC 28806 | 2017-08-03 |
| 1174052138 | Olivia Sabo | Physical Medicine & Rehabilitation | 8814 Red Rd, Rockwell, NC 28138-6500 | 2017-06-05 |
| 1770180903 | Kenneth Lassiter | Physical Medicine & Rehabilitation | 1200 Murchison Rd, Fayetteville, NC 28301-4252 | 2020-10-01 |
| 1588296719 | Douglas Maccallum | Physical Medicine & Rehabilitation | 2121 E Williams St Ste 108, Apex, NC 27539-7765 | 2020-02-05 |
| 1275188484 | Edward Albert Marshall Jr. | Physical Medicine & Rehabilitation | 224 East Wilson Street, Wingate, NC 28174 | 2019-08-05 |
| 1841784170 | Jordan Drew Bettleyon | Physical Medicine & Rehabilitation | 5400 Ramsey St, Fayetteville, NC 28311 | 2018-06-20 |
| 1154813756 | Willie Phillips II | Physical Medicine & Rehabilitation | 1900 Selwyn Ave, Charlotte, NC 28274-0001 | 2018-05-31 |
| 1437665361 | Novant Medical Group, Inc. | Physical Medicine & Rehabilitation | 8035 Providence Rd Ste 100, Charlotte, NC 28277-9716 | 2017-12-14 |
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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.