ANTINIQUE WILSON
NPI 1215765995
Nurse Practitioner in Antioch, CA

Active since July 24, 2024PECOS Enrolled
1104 BUCHANAN RD STE C10, ANTIOCH, CA 94509(925) 676-0505 Get Directions Write a Review

NPPES record last updated: July 24, 2024. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Antinique Wilson NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ANTINIQUE WILSON (NPI 1215765995) is an individual nurse practitioner in Antioch, California, licensed in California (95025241) and active in the NPI registry since July 2024. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1215765995
Entity TypeIndividualFemale
Primary Taxonomy363L00000X
Provider Legal NameANTINIQUE WILSON
Location Address1104 BUCHANAN RD STE C10Antioch, CA 94509-4226
Mailing Address2420 Sand Creek Rd # 130Brentwood, CA 94513-2707
Sole ProprietorNo
Enumeration DateJuly 24, 2024
NPPES CertifiedJuly 24, 2024
NPI 1215765995 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363L00000X
License Licensed in CA · 95025241
Definition

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

1104 BUCHANAN RD STE C10, Antioch, CA 94509

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare (PECOS)

Antinique Wilson is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 94509 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$104.51 typical visit price
range $69.00 – $202.35
Typical copayment $26.12 (range $17.25 – $50.58)
Most-billed visit code 99203
Established Patient
$119.48 typical visit price
range $23.44 – $166.46
Typical copayment $29.87 (range $5.86 – $41.61)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Nurse Practitioner (Obstetrics & Gynecology)
1104 BUCHANAN RD STE C10
ANTIOCH, CA 94509
Advanced Practice Midwife
1104 BUCHANAN RD STE C10
ANTIOCH, CA 94509
Marriage & Family Therapist
1104 BUCHANAN RD STE C10
ANTIOCH, CA 94509

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1215765995, enumerated as an "individual" on July 24, 2024.

The provider is located at 1104 BUCHANAN RD STE C10 ANTIOCH, CA 94509 and the phone number is (925) 676-0505.

Nurse Practitioner with taxonomy code 363L00000X.