Individual provider Active NPI

Rebecca Comire Wilcox, MED, MS, CAS

  • School Psychologist
  • Fleming Island, FL
National Provider Identifier
1104216951
Registry record updated Feb 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
School PsychologistTaxonomy code 103TS0200X
License
10279824 Issued in IN
Practice address
286 Eventide Dr
Fleming Island, FL 32003-8186
Phone
(904) 624-0882
NPI assigned
Feb 2, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X A10449 NC
School Psychologist 103TS0200X SS1330 FL
School Psychologist 103TS0200X PPS-0601178 VA
School Psychologist 103TS0200X 10279824 IN Primary

Addresses

Primary practice location

286 Eventide Dr
Fleming Island, FL 32003-8186

Mailing address

286 Eventide Dr
Fleming Island, FL 32003-8186
Phone (904) 624-0882

Other practice location 1

1311 Goldie St
Suite A
Kill Devil Hills, NC 27948-7519
Phone (252) 722-3308

Other practice location 2

1389 Saint Gaspar Dr W
Rensselaer, IN 47978-7361
Phone (219) 866-8540

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
Master of Education, Master of Science

State licenses

LicenseStateTypeSpecialty
A10449NCMDProfessional Counselor
SS1330FLMDSchool Psychologist
10279824INMDSchool Psychologist
PPS-0601178VAMDSchool Psychologist

NPI Registry JSON

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

{
    "created_epoch": "1422835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740096000000",
    "number": "1104216951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "286 EVENTIDE DR",
            "city": "FLEMING ISLAND",
            "state": "FL",
            "postal_code": "320038186",
            "telephone_number": "904-624-0882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "286 EVENTIDE DR",
            "city": "FLEMING ISLAND",
            "state": "FL",
            "postal_code": "320038186",
            "telephone_number": "904-624-0882"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1311 Goldie St",
            "address_2": "Suite A",
            "address_purpose": "LOCATION",
            "city": "Kill Devil Hills",
            "state": "NC",
            "postal_code": "279487519",
            "country_code": "US",
            "telephone_number": "252-722-3308",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1389 Saint Gaspar Dr W",
            "address_purpose": "LOCATION",
            "city": "Rensselaer",
            "state": "IN",
            "postal_code": "479787361",
            "country_code": "US",
            "telephone_number": "219-866-8540",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILCOX",
        "first_name": "REBECCA",
        "middle_name": "COMIRE",
        "credential": "MED, MS, CAS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-02-02",
        "last_updated": "2025-02-21",
        "certification_date": "2025-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "A10449",
            "primary": false
        },
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "FL",
            "license": "SS1330",
            "primary": false
        },
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "VA",
            "license": "PPS-0601178",
            "primary": false
        },
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "IN",
            "license": "10279824",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fleming Island, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2025; 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.