| Destonee Wilson, PA-C | |
|
1650 S Beach St, Fort Worth, TX 76105 | |
| (817) 702-1100 | |
| (817) 702-6124 |
| Full Name | Destonee Wilson |
|---|---|
| Gender | Female |
| Speciality | Physician Assistant |
| Experience | 9 Years |
| Location | 1650 S Beach St, Fort Worth, Texas |
| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174041578 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363A00000X | Physician Assistant | 279726-1206 (Utah) | Secondary |
| 363A00000X | Physician Assistant | PA12177 (Texas) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Warm Springs Rehab Hospital Of San Antonio Llc | San antonio, TX | Inpatient rehabilitation facility |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Privia Medical Group Gulf Coast Pllc | 4688999022 | 511 |
| Entity Name | Privia Medical Group Gulf Coast PLLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1578969465 PECOS PAC ID: 4688999022 Enrollment ID: O20150206000763 |
| Entity Name | Acclaim Physician Group Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1780076562 PECOS PAC ID: 4587963582 Enrollment ID: O20160426000707 |
| Mailing Address | Practice Location Address |
|---|---|
| Destonee Wilson, PA-C Po Box 732973, Dallas, TX 75373-2973 Ph: (817) 702-8450 | Destonee Wilson, PA-C 1650 S Beach St, Fort Worth, TX 76105 Ph: (817) 702-1100 |
Phillip Steven Woessner, PA-C Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 1325 Pennsylvania Ave Ste 890, Fort Worth, TX 76104 Phone: 817-250-4280 Fax: 817-250-4281 |
Shane Kelleher, PA-C Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 1500 Cooper St, Fort Worth, TX 76104 Phone: 682-885-7840 Fax: 682-885-7856 |
Danielle Purcell Lopez, PA Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 2332 Beverly Hills Dr, Fort Worth, TX 76114 Phone: 817-378-0855 Fax: 817-378-0861 |
Jaimie Ann Story, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 6900 Harris Pkwy Ste 310, Fort Worth, TX 76132 Phone: 817-375-5200 |
Benjamin Craig, PA-C Physician Assistant Medicare: Medicare Enrolled Practice Location: 1500 Cooper St, Fort Worth, TX 76104 Phone: 682-885-2500 Fax: 682-885-2510 |
Sharyl Workman, PA Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 1500 S Main St, Fort Worth, TX 76104 Phone: 817-927-1100 |
Mrs. Audrey Raquel Nelson, PA Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 901 Hemphill St, Fort Worth, TX 76104 Phone: 817-332-4060 Fax: 817-332-2304 |