Active NPI
Phyllis A. Wilson, MS
- School Psychologist
- Virginia Beach, VA
National Provider Identifier
1124378450
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- License
- 0813000386
- Practice address
- 1249 Eagle Way
Virginia Beach, VA 23456 - Phone
- (757) 471-2714
- NPI assigned
- Sep 13, 2012
- Sex
- Female
- 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 |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | 0813000386 | VA | Primary |
Addresses
Primary practice location
1249 Eagle Way
Virginia Beach, VA 23456
Mailing address
1249 Eagle Way
Virginia Beach, VA 23456
Phone (757) 471-2714
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 Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0813000386 | VA | MD | School Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1347494400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1347494400000",
"number": "1124378450",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1249 EAGLE WAY",
"city": "VIRGINIA BEACH",
"state": "VA",
"postal_code": "23456",
"telephone_number": "757-471-2714"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1249 EAGLE WAY",
"city": "VIRGINIA BEACH",
"state": "VA",
"postal_code": "23456",
"telephone_number": "757-471-2714"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "PHYLLIS",
"middle_name": "A.",
"name_prefix": "Ms.",
"credential": "MS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-09-13",
"last_updated": "2012-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "VA",
"license": "0813000386",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Virginia Beach, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.