Wilson Pediatric Therapy LLC

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

KY 3201 Issued in KY

Legal business name

WILSON PEDIATRIC THERAPY LLC

Practice address

424 Lewis Hargett Cir # B-100
Lexington, KY 40503-3688

Phone

(859) 475-4305

Fax

(877) 804-4492

NPI assigned

Apr 5, 2013

Organization subpart

No

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

Authorized official

Name

Kresta Leigh Wilson, M.S. CCC-SLP

Title

Owner/Manager

Phone

(859) 475-4305

Specialties & licenses 7

Addresses

Other identifiers 1

Electronic endpoints 1

Tax ID family

Wilson Pediatric Therapy LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Wilson Pediatric Therapy LLC

  • Early Intervention Provider Agency
  • Lexington, KY
  • NPI 1063734333
  NPD tax ID
• Wilson Pediatric Therapy LLC

  • Clinical Social Worker
  • Lexington, KY
  • NPI 1356912612
  NPD tax ID

Locations

Practitioners 1

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

• Tina Marie Berardi, OTR

  • Pediatric Occupational Therapist
  • Lexington, KY
  • NPI 1205250099

  Pediatrics

  NPD (past)

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

{
    "created_epoch": "1365120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595289600000",
    "number": "1285977462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "424 LEWIS HARGETT CIR # B-100",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405033688",
            "telephone_number": "859-475-4305",
            "fax_number": "877-804-4492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "424 LEWIS HARGETT CIR # B-100",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405033688",
            "telephone_number": "859-475-4305",
            "fax_number": "877-804-4492"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "175 W Lowry Ln",
            "address_purpose": "LOCATION",
            "city": "Lexington",
            "state": "KY",
            "postal_code": "405033012",
            "country_code": "US",
            "telephone_number": "859-475-4305",
            "fax_number": "877-804-4492",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "401 Lewis Hargett Cir Ste 120",
            "address_purpose": "LOCATION",
            "city": "Lexington",
            "state": "KY",
            "postal_code": "405033564",
            "country_code": "US",
            "telephone_number": "859-475-4305",
            "fax_number": "877-804-4492",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WILSON PEDIATRIC THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-05",
        "last_updated": "2020-07-21",
        "certification_date": "2020-07-21",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "KRESTA",
        "authorized_official_middle_name": "LEIGH",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "859-475-4305",
        "authorized_official_credential": "M.S. CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Pediatrics",
            "state": "KY",
            "license": "005311",
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "KY",
            "license": "R4342",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "KY",
            "license": "KY 3201",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "KY",
            "license": "KY 3472",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "KY",
            "license": "KY 4155",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "KY",
            "license": "KY 3597",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100658910",
            "state": "KY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "kresta@wilsonpediatric.com",
            "affiliation": "N",
            "address_1": "424 Lewis Hargett Cir # B-100",
            "city": "Lexington",
            "state": "KY",
            "country_code": "US",
            "postal_code": "405033688",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lucius Willson, ATC
• Theresa Ann Wilp, APRN
• H Andrew Wilsey, PHARMD
• Andrea Taylor Wilson Graf
• Wilson Pediatric Therapy LLC
• Wilson Pediatric Therapy LLC
• Gara Wilson-Casteel
• Adam J Wilson, CNP
• Alexandra Wilson, RN
• Alexandria Lauren Wilson, PA

• Speech-Language Pathologist in Lexington, KY
• Providers in Lexington, KY by specialty
• Speech-Language Pathologist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.