Active NPI
Kenneth Paul Adams, PSYD
- Clinical Psychologist
- Clarksville, TN
National Provider Identifier
1295036333
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 34618
- Practice address
- 2395 Loupin Dr Apt 51B
Clarksville, TN 37042-7570 - Phone
- (210) 374-5002
- NPI assigned
- Nov 5, 2010
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 34618 | TX | Primary |
Addresses
Primary practice location
2395 Loupin Dr Apt 51B
Clarksville, TN 37042-7570
Mailing address
2395 Loupin Dr Apt 51B
Clarksville, TN 37042-7570
Phone (210) 374-5002
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2182644-03 | Medicaid | TX | |
| 34618 | Other | TX | LICENSE |
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)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Deer Oaks Mental Health Associates PC | Clinical | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1288915200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1694995200000",
"number": "1295036333",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2395 LOUPIN DR APT 51B",
"city": "CLARKSVILLE",
"state": "TN",
"postal_code": "370427570",
"telephone_number": "210-374-5002"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2395 LOUPIN DR APT 51B",
"city": "CLARKSVILLE",
"state": "TN",
"postal_code": "370427570",
"telephone_number": "210-374-5002"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ADAMS",
"first_name": "KENNETH",
"middle_name": "PAUL",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-11-05",
"last_updated": "2023-09-18",
"certification_date": "2023-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "TX",
"license": "34618",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2182644-03",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "34618",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Clarksville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.