NPIMap

Organization Active NPI

Wilson Psychological Associates PLLC

  • Psychologist
  • Bartlesville, OK
National Provider Identifier
1144326265
Registry record updated Sep 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
966 Issued in OK
Legal business name
WILSON PSYCHOLOGICAL ASSOCIATES PLLC
Practice address
501 S Johnstone Ave
Suite 503
Bartlesville, OK 74003-6622
Phone
(918) 337-6050
Fax
(918) 337-6061
NPI assigned
Sep 15, 2006
Reactivated
Sep 21, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Kenneth Spencer Wilson, PHDNPI 1366400707
Title
Psychologist
Phone
(918) 337-6050

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103T00000X 966 OK Primary

Addresses

Primary practice location

501 S Johnstone Ave
Suite 503
Bartlesville, OK 74003-6622

Mailing address

501 S Johnstone Ave
Suite 503
Bartlesville, OK 74003-6622
Phone (918) 337-6050

Other identifiers 2

IdentifierTypeStateIssuer
200522095OtherOKMEDICARE NUMBER
200029610AMedicaidOK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040726000640 OK Part B Supplier - Clinic/Group Practice 7113907452 Receives reassigned benefits from 6 practitioners
Practice locations: Bartlesville, OK

National Provider Directory

National Provider Directory

Locations

501 S Johnstone Ave
Ste 601
Bartlesville, OK 74003
Phone (918) 337-6050

501 S Johnstone Ave
Ste 503
Bartlesville, OK 74003
Phone (918) 337-6050

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695254400000",
    "number": "1144326265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 S JOHNSTONE AVE",
            "address_2": "SUITE 503",
            "city": "BARTLESVILLE",
            "state": "OK",
            "postal_code": "740036622",
            "telephone_number": "918-337-6050",
            "fax_number": "918-337-6061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 S JOHNSTONE AVE",
            "address_2": "SUITE 503",
            "city": "BARTLESVILLE",
            "state": "OK",
            "postal_code": "740036622",
            "telephone_number": "918-337-6050",
            "fax_number": "918-337-6061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILSON PSYCHOLOGICAL ASSOCIATES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-15",
        "last_updated": "2023-09-21",
        "deactivation_date": "2023-09-06",
        "reactivation_date": "2023-09-21",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "SPENCER",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "918-337-6050",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "OK",
            "license": "966",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE NUMBER",
            "identifier": "200522095",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200029610A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bartlesville, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.