Wilson, Russell Carl
Wilson, Russell Carl is an individual health care provider with primary practice located at 1125 Raintree Cir Ste 100 , Allen TX 75013-5289. He recently has 3 registered licenses in different health care specialties including Emergency Medical Service Providers / Emergency Medical Technician, Paramedic, Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Athletic Trainer, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is his primary health care specialty. Wilson, Russell Carl can be contacted via phone (972) 727-9995.Contact Information
Primary practice address
1125 Raintree Cir Ste 100
Allen TX 75013-5289
Phone: (972) 727-9995
Fax: (972) 727-8350
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Emergency Medical Service Providers / Emergency Medical Technician, Paramedic | 146L00000X | 45448 | Texas |
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Athletic Trainer | 2255A2300X | 020202111 | Nebraska |
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | PA.0005767 | Colorado |
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | 1092900 | Texas |
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | PA06802 | Texas |
Profile Details
| NPI number | 1780675967 |
|---|---|
| LBN Legal business name | Wilson, Russell Carl |
| Credentials | P.A.-C, A.T.C. |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 4th, 2005 |
| Last updated | Sep 20th, 2022 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1780675967 | NPPES |
| Texas | MEDICAID | 360930704 | |
| Texas | Other | 8029NH |
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