Theresa Bergen Wade, APRN

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

APRN - 1950 Issued in HI

Practice address

83-5737 Kanele St
Captain Cook, HI 96704

Phone

(808) 333-5977

NPI assigned

Dec 14, 2005

Last updated

Jan 23, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 6

Addresses

Other names 1

• Ms. Theresa Annette Wade Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Theresa Wade, Aprn LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Kealakekua, HI
  • NPI 1861850570
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1134518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548201600000",
    "number": "1063497758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "83-5737 KANELE ST",
            "city": "CAPTAIN COOK",
            "state": "HI",
            "postal_code": "967048329",
            "telephone_number": "808-333-5977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "83-5737 KANELE ST",
            "city": "CAPTAIN COOK",
            "state": "HI",
            "postal_code": "96704",
            "telephone_number": "808-333-5977"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "79-7446 Mamalahoa Hwy",
            "address_purpose": "LOCATION",
            "city": "Kealakekua",
            "state": "HI",
            "postal_code": "967507913",
            "country_code": "US",
            "telephone_number": "808-393-0677",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "79-7446 Mamalahoa Hwy",
            "address_purpose": "LOCATION",
            "city": "Kealakekua",
            "state": "HI",
            "postal_code": "967507913",
            "country_code": "US",
            "telephone_number": "808-393-0677",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WADE",
        "first_name": "THERESA",
        "middle_name": "BERGEN",
        "name_prefix": "Ms.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-14",
        "last_updated": "2019-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "7512",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "HI",
            "license": "APRN - 1950",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "7512",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "509869",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "7512",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "HI",
            "license": "APRN - 1950",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "THERESA",
            "last_name": "WADE",
            "middle_name": "ANNETTE",
            "prefix": "MS.",
            "credential": "APRN",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Paula M Rozman, LPN
• South Kona Physical Therapy
• Sydney Steiner
• Sylvia an Ross PHD LLC
• Kimberly R Turnbull, RN, DC
• West Hawaii Community Health Center, Inc (Hawaii Island Community Health Center)
• Julie W Williams, RN-BSN
• Neil Charles Williamson
• Ian Matthew Work
• Zahava Zaidoff, CSAC, M-RAS

• Psychiatric/Mental Health Nurse Practitioner in Captain Cook, HI
• Providers in Captain Cook, HI by specialty
• Psychiatric/Mental Health Nurse Practitioner in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.