Individual provider Active NPI

Sarah Elizabeth Wellman, PSYD

  • Psychologist
  • Goodlettsville, TN
National Provider Identifier
1306170410
Registry record updated Feb 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
3508 Issued in TN
Practice address
104 Wilt CT
Goodlettsville, TN 37072-7080
Phone
(502) 855-9745
NPI assigned
Sep 22, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PSYLIP00211375 KY
Psychologist 103T00000X 3508 TN Primary

Addresses

Primary practice location

104 Wilt CT
Goodlettsville, TN 37072-7080

Mailing address

PO Box 614
Hopkinsville, KY 42241-0614
Phone (270) 886-2205

Other identifiers 1

IdentifierTypeStateIssuer
1306170410MedicaidTN

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20171206002755 TN Practitioner - Clinical Psychologist 0840411021 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
3508TNMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
NV Pacs 2 LLC CurrentSince Aug 20, 2021 Accepting new patients

Locations

880 S Mohawk Dr
Erwin, TN 37650
Phone (423) 743-7669

731 Castle Heights Ct
Lebanon, TN 37087
Phone (615) 444-4319

832 Wedgewood Ave
Nashville, TN 37203
Phone (615) 202-4233

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1253577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707955200000",
    "number": "1306170410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 614",
            "city": "HOPKINSVILLE",
            "state": "KY",
            "postal_code": "422410614",
            "telephone_number": "270-886-2205",
            "fax_number": "270-886-0392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 WILT CT",
            "city": "GOODLETTSVILLE",
            "state": "TN",
            "postal_code": "370727080",
            "telephone_number": "502-855-9745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WELLMAN",
        "first_name": "SARAH",
        "middle_name": "ELIZABETH",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-22",
        "last_updated": "2024-02-15",
        "certification_date": "2024-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "KY",
            "license": "PSYLIP00211375",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "TN",
            "license": "3508",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1306170410",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Goodlettsville, TN

Sources for this page

Verify at the official NPI Registry.