Active NPI
Louis Wynne, PH.D.
- Psychologist
- Albuquerque, NM
National Provider Identifier
1104908334
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 140
- Practice address
- 1420 Carlisle Blvd NE
#109
Albuquerque, NM 87110-5660 - Phone
- (505) 280-4400
- Fax
- (505) 897-4977
- NPI assigned
- Oct 19, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 140 | NM | Primary |
Addresses
Primary practice location
1420 Carlisle Blvd NE
#109
Albuquerque, NM 87110-5660
Mailing address
1420 Carlisle Blvd NE
#109
Albuquerque, NM 87110-5660
Phone (505) 280-4400
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 |
|---|---|---|---|
| 140 | NM | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161216000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1104908334",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1420 CARLISLE BLVD NE",
"address_2": "#109",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871105660",
"telephone_number": "505-280-4400",
"fax_number": "505-897-4977"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1420 CARLISLE BLVD NE",
"address_2": "#109",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871105660",
"telephone_number": "505-280-4400",
"fax_number": "505-897-4977"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WYNNE",
"first_name": "LOUIS",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NM",
"license": "140",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.