Active NPI
Carmenita Jiles, PHD
- Clinical Psychologist
- Stockton, CA
National Provider Identifier
1083869440
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY31243
- Practice address
- 7707 Austin Rd
Stockton, CA 95215-8312 - Phone
- (209) 467-2500
- NPI assigned
- Nov 25, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | |||
| Psychologist | 103T00000X | |||
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Clinical Psychologist | 103TC0700X | PSY31243 | CA | Primary |
Addresses
Primary practice location
7707 Austin Rd
Stockton, CA 95215-8312
Mailing address
153 W Invitar LN
Mountain House, CA 95391-2036
Phone (510) 415-4038
Other practice location 1
3200 Adeline St
Berkeley, CA 94703-2407
Phone (510) 601-0203
Other names 1
- Carmenita Jiles-Nabwe
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY31243 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1227571200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1693958400000",
"number": "1083869440",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "153 W INVITAR LN",
"city": "MOUNTAIN HOUSE",
"state": "CA",
"postal_code": "953912036",
"telephone_number": "510-415-4038"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7707 AUSTIN RD",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952158312",
"telephone_number": "209-467-2500"
}
],
"practiceLocations": [
{
"address_1": "3200 Adeline St",
"address_purpose": "LOCATION",
"city": "Berkeley",
"state": "CA",
"postal_code": "947032407",
"country_code": "US",
"telephone_number": "510-601-0203",
"fax_number": "510-601-4002",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JILES",
"first_name": "CARMENITA",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-11-25",
"last_updated": "2023-09-06",
"certification_date": "2023-09-06",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": null,
"license": null,
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY31243",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "CARMENITA",
"last_name": "JILES-NABWE",
"credential": "PHD",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Stockton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.