AUDREY M WILSON (APN) – Nurse Practitioner, NPI 1447081948

Nurse Practitioner

AUDREY M WILSON (APN) is a healthcare provider. based in Manitowoc, Wisconsin. specializing in NURSE PRACTITIONER. They hold the professional credentials APN. They hold a License No. 209.030186 (IL). The NPI Number for AUDREY M WILSON (APN) is 1447081948

Main info

Female

2 Years Of Experience

Accepts Medicare Assignment

Name

AUDREY M WILSON (APN)

NPI

1447081948

Phone

(920) 663-9008

Address

801 YORK ST

Enumeration Date

8 August 2024

Last Update Date

13 August 2025

Doctor Profile

Medical School Name

OTHER

Secondary Phone

30966288139

Graduation Year

2024 (2 years ago)

PAC ID

2668900804

Group Practice PAC ID

8921084476

Professional Enrollment ID

I20250115002314

Address ID

IL617017904BL1404XDRXX304

Contacts

Secure Messaging

Audrey.Wilson@forefrontdermatology.emadirect.md

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience26

Completeness95

Years active:1State licenses:1Other names

7,023 NURSE PRACTITIONER in MO

Provider Addresses for AUDREY M WILSON (APN)

801 YORK ST
MANITOWOC, WI 542204630
Phone: (920) 663-9008
Fax: (920) 684-1439
Type: Mailing
5700 MEXICO RD STE 14
SAINT PETERS, MO 633761667
Phone: (636) 277-0371
Fax: (636) 447-4161
Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2025-08-11

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking 2 Medicare enrollment records; no due dates published yet.

Enrollment records

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

Medicare enrolled
On CMS revalidation list
Due date assigned
Revalidate in PECOS

CMS enrollment records

Enrollment ID	Type	Specialty	State	Due date
I20250115002314	I	Nurse Practitioner	IL	TBD
I20250811001295	I	Nurse Practitioner	MO	TBD

What to do next

No action required while the due date shows TBD.
Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 54220)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 8921084476View full group profile

Name	Specialty	State
NICHOLE CHRISTINE RAVE (PA-C)	Physician Assistant	IL
MRS. ERIN S REDD (APN CNP)	Nurse Practitioner	IL
MR. THOMAS RICHARD BRANDER (MD)	D E R M A T O L O G Y	IL
MRS. LUCY NELSON WISDOM (MD)	D E R M A T O L O G Y	IL
KALI A FEVER (APN, CNP)	Nurse Practitioner	IL