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1407405020 NPI number — HAYLIE N WILSON PA

NPI Number: 1407405020
Health Care Provider/Practitioner: HAYLIE N WILSON PA

Information about “1407405020” NPI (HAYLIE N WILSON PA) exists in 1407405020 in HTML format HTML  |  1407405020 in plain Text format TXT  |  1407405020 in PDF (Portable Document Format) PDF  |  1407405020 in an XML format XML  formats.

NPI Number : 1407405020 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1407405020",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WILSON",
    "FirstName": "HAYLIE",
    "MiddleName": "N",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1275 DICK LONAS RD UNIT 101",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "KNOXVILLE",
    "MailingAddressStateName": "TN",
    "MailingAddressPostalCode": "37909-1383",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "865-584-4747",
    "MailingAddressFaxNumber": "833-908-0998",
    "FirstLinePracticeLocationAddress": "2519 WILLOW POINT WAY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "KNOXVILLE",
    "PracticeLocationAddressStateName": "TN",
    "PracticeLocationAddressPostalCode": "37931-3162",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "865-694-9349",
    "PracticeLocationAddressFaxNumber": "865-694-9883",
    "EnumerationDate": "09/06/2019",
    "LastUpdateDate": "11/18/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363AM0700X",
        "TaxonomyName": "Medical Physician Assistant",
        "LicenseNumber": "3966",
        "LicenseNumberStateCode": "TN",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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