Kevin S Weatherly, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

37657 Issued in TX

Practice address

5604 Wesley St Ste 104
Greenville, TX 75402-6326

Phone

(903) 883-7792

Fax

(903) 488-5303

NPI assigned

Jun 20, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Gloria Rodarte Brun, M. D., P. a.

  • Child & Adolescent Psychiatry Physician
  • Greenville, TX
  • NPI 1255462917
  NPD (past)

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

{
    "created_epoch": "1340150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688601600000",
    "number": "1164785556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5604 WESLEY ST STE 104",
            "city": "GREENVILLE",
            "state": "TX",
            "postal_code": "754026326",
            "telephone_number": "903-883-7792",
            "fax_number": "903-488-5303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5604 WESLEY ST STE 104",
            "city": "GREENVILLE",
            "state": "TX",
            "postal_code": "754026326",
            "telephone_number": "903-883-7792",
            "fax_number": "903-488-5303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEATHERLY",
        "first_name": "KEVIN",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-06-20",
        "last_updated": "2023-07-06",
        "certification_date": "2023-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "37657",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "TX",
            "license": "37657",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "375679301",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.availity.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "5604 Wesley St Ste 104",
            "city": "Greenville",
            "state": "TX",
            "country_code": "US",
            "postal_code": "754026326",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Eric Wang, DDS
• Gregory Scott Ward, FNP, AGACNP
• Michael David Weaks, D.DS
• Ronald David Weaks, D.D.S.
• Kindell Weatherford, LCSW
• Amy Weems, LPC
• Brent S. Wehner, D.D.S.
• Jessica Weido, DO
• Wellgen Health System Inc
• Wesley Dental Group PLLC

• Psychologist in Greenville, TX
• Providers in Greenville, TX by specialty
• Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.