MR. DEREK EDWARD WILSON PA-C
NPI 1417034026
Physician Assistant - Medical in Independence, KS

Q: What is Derek Wilson's NPI number?

The NPI number for Derek Wilson is 1417034026. It was assigned to this individual provider in the NPPES registry on November 1, 2006.

Q: What is Derek Wilson's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Q: When was this NPI record last updated?

The NPPES record for Derek Wilson was last updated on January 14, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 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 November 01, 2006PECOS Enrolled

800 W LAUREL ST, INDEPENDENCE, KS 67301(620) 332-3280(620) 332-3281 Get Directions Write a Review

NPPES record last updated: January 14, 2010. Verified against the NPPES registry weekly; last sync: August 30, 2026.

On this page

About Mr. Derek Edward Wilson Pa-c NPPES

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

MR. DEREK EDWARD WILSON PA-C (NPI 1417034026) is an individual medical provider in Independence, Kansas, licensed in Kansas (1501140) and active in the NPI registry since November 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1417034026

Entity TypeIndividualMale

Primary Taxonomy363AM0700X

Provider Legal NameMR. DEREK EDWARD WILSONCredential: PA-C

Location Address800 W LAUREL STIndependence, KS 67301-3211

Mailing AddressPo Box 845Independence, KS 67301-0845 · (620) 332-3280 · Fax (620) 332-3281

Phone(620) 332-3280

Fax(620) 332-3281

Sole ProprietorNo

Enumeration DateNovember 1, 2006

Last NPPES UpdateJanuary 14, 2010

✔ NPI 1417034026 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363AM0700X

License✔ Licensed in KS · 1501140

800 W LAUREL ST, Independence, KS 67301

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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mr. Derek Edward Wilson Pa-c 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.

Other Providers at the Same Location NPPES 11

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

COMMUNITY HEALTH CENTER OF SOUTHEAST KANSAS, INC.

Clinic/Center (Federally Qualified Health Center (FQHC))