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Contact Information

JORDAN WILSON, PA-C
100 NEW STATE HWY
RAYNHAM, MA02767-5423
 Phone: 781-666-2711
 Fax: 781-666-2712
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physician Assistant

363A00000X 97 Physician Assistant
 

Behavioral Neurology & Neuropsychiatry

2084B0040X
Indicates primary specialty

NPI Profile & details for JORDAN WILSON · (Male)

NPI # 1235651720
Status Active
Credentials PA-C (Physician Assistant-Certified)
Entity Individual
Enumeration date 07/17/2017
Last updated 03/12/2025 - More than a year ago
Sole proprietor 1 No
Identifiers
  • FL License # 9110440
  • MA License # PA101388
  • WA License # PA60855409
  • WA Medicaid 2101119
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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