STEPHANIE ABIMBOLA OLAWAIYE WILDERNESS PA-C
NPI 1871054833
Physician Assistant - Medical in Houston, TX

Active since March 30, 2019PECOS Enrolled
6621 FANNIN ST, HOUSTON, TX 77030(832) 826-1075 Get Directions Write a Review

NPPES record last updated: September 10, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Stephanie Abimbola Olawaiye Wilderness Pa-c NPPES

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

STEPHANIE ABIMBOLA OLAWAIYE WILDERNESS PA-C (NPI 1871054833) is an individual medical provider in Houston, Texas, licensed in Texas (PA12712) and active in the NPI registry since March 2019. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1871054833
Entity TypeIndividualFemale
Primary Taxonomy363AM0700X
Provider Legal NameSTEPHANIE ABIMBOLA OLAWAIYE WILDERNESSCredential: PA-C
Location Address6621 FANNIN STHouston, TX 77030-2399
Mailing Address6621 Fannin StHouston, TX 77030-2399 · (832) 826-1075
Sole ProprietorNo
Enumeration DateMarch 30, 2019
Last NPPES UpdateSeptember 10, 2022
NPPES CertifiedSeptember 10, 2022
NPI 1871054833 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 TX · PA12712
6621 FANNIN ST, Houston, TX 77030

Accepted Insurance

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

Enrolled in Medicare (PECOS)

Stephanie Abimbola Olawaiye Wilderness 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 20

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

Pediatrics (Pediatric Emergency Medicine)
6621 FANNIN ST
HOUSTON, TX 77030
Pediatrics (Pediatric Emergency Medicine)
6621 FANNIN ST
HOUSTON, TX 77030
Pediatrics (Pediatric Emergency Medicine)
6621 FANNIN ST
HOUSTON, TX 77030
Physical Therapist
6621 FANNIN ST
HOUSTON, TX 77030
Physician Assistant
6621 FANNIN ST
HOUSTON, TX 77030
Anesthesiology
6621 FANNIN ST
HOUSTON, TX 77030
Pediatrics (Pediatric Endocrinology)
6621 FANNIN ST
HOUSTON, TX 77030
Pediatrics (Pediatric Hematology-Oncology)
6621 FANNIN ST, MC 3-3320
HOUSTON, TX 77030

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Stephanie Wilderness's NPI number?

The NPI number for Stephanie Wilderness is 1871054833. It was assigned to this individual provider in the NPPES registry on March 30, 2019.

Where is Stephanie Wilderness located?

Stephanie Wilderness practices at 6621 Fannin St, Houston, TX 77030. The listed phone number is (832) 826-1075.

What is Stephanie Wilderness's specialty?

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

Is Stephanie Wilderness enrolled in Medicare?

Yes. Stephanie Wilderness is registered in the Medicare PECOS enrollment system.

What insurance does Stephanie Wilderness accept?

Health plans from Moda Health Plan, Inc. list Stephanie Wilderness as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Stephanie Wilderness was last updated on September 10, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.