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NPI Code Detail

MEDICARE: MR. JAMES CARSON WILCOX II CRNA

MEDICARE: MR. JAMES CARSON WILCOX II CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse AnesthetistPENDINGNV
2367500000XCertified Registered Nurse AnesthetistAP116710TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
175876OTHERTXNATIONAL BOARD OF CERTIFICATION & RECERTIFICATION FOR NURSE ANESTHETISTS

General Provider Information

NPI Number : 1710028345
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JAMES CARSON WILCOX II CRNA
Provider Business Mailing Address
First Line : 4112 GLIDING GULLS AVE
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89084-2685
Country : US
Telephone Number : 702-487-5987
Fax Number :
Provider Business Practice Location Address
First Line : 3800 S W S YOUNG DR STE 201
Second Line :
City : KILLEEN
State : TX
Zip : 76542-3340
Country : US
Telephone Number : 254-245-9175
Fax Number : 254-213-7771
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2007
Last Update Date : 01/20/2025

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