Active NPI
Jerry Alan Van Winkle, PSY.D.
- Clinical Psychologist
- Kearney, NE
National Provider Identifier
1124115043
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 577
- Practice address
- 2315 W 39TH St
Kearney, NE 68845-8327 - Phone
- (308) 224-4664
- Fax
- (308) 237-5581
- NPI assigned
- Oct 10, 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 577 | NE | Primary |
Addresses
Primary practice location
2315 W 39TH St
Kearney, NE 68845-8327
Mailing address
2315 W 39TH St
Kearney, NE 68845-8327
Phone (308) 224-4664
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10025728500 | Medicaid | NE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 577 | NE | MD | Addiction (Substance Use Disorder) Counselor |
| 181 | NE | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160438400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1473206400000",
"number": "1124115043",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2315 W 39TH ST",
"city": "KEARNEY",
"state": "NE",
"postal_code": "688458327",
"telephone_number": "308-224-4664",
"fax_number": "308-237-5581"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2315 W 39TH ST",
"city": "KEARNEY",
"state": "NE",
"postal_code": "688458327",
"telephone_number": "308-224-4664",
"fax_number": "308-237-5581"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN WINKLE",
"first_name": "JERRY",
"middle_name": "ALAN",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-10",
"last_updated": "2016-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NE",
"license": "577",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "10025728500",
"state": "NE"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kearney, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.