MS. DOMINIQUE RENEE WILSON DNP, PMHNP, FNP
NPI 1295019909
Nurse Practitioner - Psychiatric/Mental Health in Portland, OR

Q: What is Dominique Wilson's NPI number?

The NPI number for Dominique Wilson is 1295019909. It was assigned to this individual provider in the NPPES registry on September 30, 2011.

Q: What is Dominique Wilson's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Q: When was this NPI record last updated?

The NPPES record for Dominique Wilson was last updated on May 1, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since September 30, 2011PECOS EnrolledAccepts Medicare Assignment

205 SE SPOKANE ST STE 300, PORTLAND, OR 97202(855) 704-2004(503) 386-3366 Get Directions Write a Review

NPPES record last updated: May 1, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: May 1, 2024, Jul 21, 2023, May 23, 2023 and 3 more (6 updates tracked since 2021).

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About Ms. Dominique Renee Wilson Dnp, Pmhnp, Fnp NPPES

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

MS. DOMINIQUE RENEE WILSON DNP, PMHNP, FNP (NPI 1295019909) is an individual psychiatric/mental health provider in Portland, Oregon, licensed in Oregon (202100794NP) and active in the NPI registry since September 2011. She is enrolled in Medicare PECOS, maintains 2 additional practice locations, and is a graduate of Other (2018).

NPPES Registry Identity

NPI1295019909

Entity TypeIndividualFemale

Primary Taxonomy363LP0808X

Provider Legal NameMS. DOMINIQUE RENEE WILSONCredential: DNP, PMHNP, FNP

Location Address205 SE SPOKANE ST STE 300Portland, OR 97202-6487

Mailing Address205 Se Spokane St Ste 300Portland, OR 97202-6487 · (855) 704-2004 · Fax (503) 386-3366

Phone(855) 704-2004

Fax(503) 386-3366

Sole ProprietorNo

Medical School CMSOtherGraduated 2018

Enumeration DateSeptember 30, 2011

Last NPPES UpdateMay 1, 20246 updates tracked since enumeration

NPPES CertifiedMay 1, 2024

✔ NPI 1295019909 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LP0808X

Licenses✔ Licensed in OR · 202100794NP✔ Licensed in WA · AP61131624✔ Licensed in TX · AP119115

Also ListedNurse Practitioner · FamilyTaxonomy 363LF0000X · License AP119115 (TX), 202100794NPPP (OR)

205 SE SPOKANE ST STE 300, Portland, OR 97202

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Secondary Practice Locations 2

Location 1401 Broadway Ste 100Tacoma, WA 98402-3900 · Phone (855) 704-2004 · Fax (503) 386-3366

Location 22000 E LaMar Blvd Ste 600Arlington, TX 76006-7361 · Phone (855) 704-2004 · Fax (503) 386-3366

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Texas, BridgeSpan Health Company, Kaiser Permanente and more.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Ms. Dominique Renee Wilson Dnp, Pmhnp, Fnp is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID9133380223

PECOS Enrollment IDI20210422002882

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 97202 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

$90.51 typical visit price

range $58.99 – $176.88

Typical copayment $22.62 (range $14.74 – $44.22)

Most-billed visit code 99203

Established Patient

$103.51 typical visit price

range $19.32 – $144.79

Typical copayment $25.87 (range $4.83 – $36.19)

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 20

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

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