Healthcare Provider Details

I. General information

NPI: 1437473998
Provider Name (Legal Business Name): JASON A WILSON APRN- NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2010
Last Update Date: 07/12/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 BALD HILL RD STE 530
WARWICK RI
02886-6111
US

IV. Provider business mailing address

400 BALD HILL RD STE 530
WARWICK RI
02886-6111
US

V. Phone/Fax

Practice location:
  • Phone: 401-785-0040
  • Fax:
Mailing address:
  • Phone: 401-349-3131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG105783
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN02195
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: