NPIMap

Organization Active NPI

Wilson Pediatric Therapy LLC

  • Early Intervention Provider Agency
  • Lexington, KY
National Provider Identifier
1063734333
Registry record updated Sep 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Early Intervention Provider AgencyTaxonomy code 252Y00000X
License
3201 Issued in KY
Legal business name
WILSON PEDIATRIC THERAPY LLC
Practice address
424 Lewis Hargett Cir # B-100
Lexington, KY 40503-3688
Phone
(859) 475-4305
Fax
(877) 804-4492
NPI assigned
Feb 26, 2010
Last updated
Sep 24, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2020

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

Authorized official

Name
Mrs. Kresta Leigh Wilson, M.S. CCC-SLPNPI 1457478570
Title
Owner/Speech Language Pathologist
Phone
(859) 806-5717

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Early Intervention Provider Agency 252Y00000X 3201 KY Primary

Addresses

Primary practice location

424 Lewis Hargett Cir # B-100
Lexington, KY 40503-3688

Mailing address

424 Lewis Hargett Cir # B-100
Lexington, KY 40503-3688
Phone (859) 475-4305

Other practice location 1

401 Lewis Hargett Cir Ste 120
Lexington, KY 40503
Phone (859) 475-4305

Other identifiers 1

IdentifierTypeStateIssuer
7100658910MedicaidKY

National Provider Directory

National Provider Directory
Tax ID family
Wilson Pediatric Therapy LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

175 W Lowry Ln
Ste 104
Lexington, KY 40503
Phone (859) 457-6119

401 Lewis Hargett Cir
Ste 120
Lexington, KY 40503
Phone (859) 457-4305

424 Lewis Hargett Cir
Ste B100
Lexington, KY 40503
Phone (859) 475-4305

Practitioners & affiliated clinicians

Practitioners 38

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1267142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600905600000",
    "number": "1063734333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "424 LEWIS HARGETT CIR # B-100",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405033688",
            "telephone_number": "859-475-4305",
            "fax_number": "877-804-4492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "424 LEWIS HARGETT CIR # B-100",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405033688",
            "telephone_number": "859-475-4305",
            "fax_number": "877-804-4492"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "401 Lewis Hargett Cir Ste 120",
            "address_purpose": "LOCATION",
            "city": "Lexington",
            "state": "KY",
            "postal_code": "40503",
            "country_code": "US",
            "telephone_number": "859-475-4305",
            "fax_number": "877-804-4492",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WILSON PEDIATRIC THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-26",
        "last_updated": "2020-09-24",
        "certification_date": "2020-08-03",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "KRESTA",
        "authorized_official_middle_name": "LEIGH",
        "authorized_official_title_or_position": "OWNER/SPEECH LANGUAGE PATHOLOGIST",
        "authorized_official_telephone_number": "859-806-5717",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "M.S. CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "KY",
            "license": "3201",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100658910",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lexington, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2020; 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.