Active NPI
Philip W Wickline
- Clinical Psychologist
- Harrisonburg, VA
National Provider Identifier
1124306899
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 0810004444
- Practice address
- 644 University Blvd
Harrisonburg, VA 22801-3750 - Phone
- (540) 437-7866
- Fax
- (540) 433-4338
- NPI assigned
- Jul 29, 2011
- Sex
- Male
- 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 | 0810004444 | VA | Primary |
Addresses
Primary practice location
644 University Blvd
Harrisonburg, VA 22801-3750
Mailing address
PO Box 1430
Harrisonburg, VA 22803-1430
Phone (540) 437-7989
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0810004444 | VA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1311897600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1311897600000",
"number": "1124306899",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1430",
"city": "HARRISONBURG",
"state": "VA",
"postal_code": "228031430",
"telephone_number": "540-437-7989",
"fax_number": "540-433-4123"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "644 UNIVERSITY BLVD",
"city": "HARRISONBURG",
"state": "VA",
"postal_code": "228013750",
"telephone_number": "540-437-7866",
"fax_number": "540-433-4338"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WICKLINE",
"first_name": "PHILIP",
"middle_name": "W",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-07-29",
"last_updated": "2011-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "VA",
"license": "0810004444",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Harrisonburg, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.