Active NPI
Jeanine Wade, PHD
- Psychologist
- Round Rock, TX
National Provider Identifier
1164573697
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 24694
- Practice address
- 400 W Main Ave
Suite 211
Round Rock, TX 78664-5808 - Phone
- (512) 860-2963
- NPI assigned
- Jan 12, 2007
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 24694 | TX | Primary |
Addresses
Primary practice location
400 W Main Ave
Suite 211
Round Rock, TX 78664-5808
Mailing address
400 W Main Ave
Suite 211
Round Rock, TX 78664-5808
Phone (512) 860-2963
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
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24694 | TX | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168560000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1164573697",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 W MAIN AVE",
"address_2": "SUITE 211",
"city": "ROUND ROCK",
"state": "TX",
"postal_code": "786645808",
"telephone_number": "512-860-2963"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 W MAIN AVE",
"address_2": "SUITE 211",
"city": "ROUND ROCK",
"state": "TX",
"postal_code": "786645808",
"telephone_number": "512-860-2963"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WADE",
"first_name": "JEANINE",
"name_prefix": "Ms.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "TX",
"license": "24694",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Round Rock, TX
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.