Provider Demographics
NPI:1144539222
Name:WILSON-KAYSSER, TERRA LEE (CMA)
Entity type:Individual
Prefix:MRS
First Name:TERRA
Middle Name:LEE
Last Name:WILSON-KAYSSER
Suffix:
Gender:F
Credentials:CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 MAUREEN LN
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-2142
Mailing Address - Country:US
Mailing Address - Phone:925-798-9696
Mailing Address - Fax:
Practice Address - Street 1:517 MAUREEN LN
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-2142
Practice Address - Country:US
Practice Address - Phone:925-798-9696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-06
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16927247000000X
CA261469363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information
Provider Identifiers
StateIdentifier IDID TypeIssuer
16927OtherNATIONAL COMMISSION FOR HEALTH EDUCATION CREDENTIALING, INC.
261469OtherAMERICAN ASSOCIATION OF MEDICAL ASSISTANTS