Active NPI
Theresa Anne Faulkner, PH.D.
- Clinical Psychologist
- Buffalo, WY
National Provider Identifier
1104807593
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- #268
- Practice address
- 135 Pine St
Suite B
Buffalo, WY 82834-2332 - Phone
- (307) 684-5828
- Fax
- (307) 684-5803
- NPI assigned
- Nov 11, 2005
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | #268 | WY | Primary |
Addresses
Primary practice location
135 Pine St
Suite B
Buffalo, WY 82834-2332
Mailing address
135 Pine St
Suite B
Buffalo, WY 82834-2332
Phone (307) 684-5828
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| #268 | WY | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rehabilitation Enterprises of Northeastern Wyoming | Clinical | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinical Psychologist
- Sheridan, WY
- NPI 1689716227
Clinical
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131667200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1228867200000",
"number": "1104807593",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "135 PINE ST",
"address_2": "SUITE B",
"city": "BUFFALO",
"state": "WY",
"postal_code": "828342332",
"telephone_number": "307-684-5828",
"fax_number": "307-684-5803"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "135 PINE ST",
"address_2": "SUITE B",
"city": "BUFFALO",
"state": "WY",
"postal_code": "828342332",
"telephone_number": "307-684-5828",
"fax_number": "307-684-5803"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAULKNER",
"first_name": "THERESA",
"middle_name": "ANNE",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-11-11",
"last_updated": "2008-12-10",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WY",
"license": "#268",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Buffalo, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.